Staple cartridge assembly including a compressible adjunct

ABSTRACT

A staple cartridge assembly for use with a surgical stapling instrument includes a staple cartridge including a plurality of staples and a cartridge deck. The staple cartridge assembly also includes a compressible adjunct positionable against the cartridge deck, wherein the staples are deployable into tissue captured against the compressible adjunct, and wherein the compressible adjunct comprises a first biocompatible layer comprising a first portion, a second biocompatible layer comprising a second portion, and crossed spacer fibers extending between the first portion and the second portion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 17/061,764, entitledCOMPRESSIBLE ADJUNCT WITH CROSSING SPACER FIBERS, filed Oct. 2, 2020,which issued on Jan. 17, 2023 as U.S. Pat. No. 11,553,916, which is acontinuation application claiming priority under 35 U.S.C. § 120 to U.S.patent application Ser. No. 16/229,607, entitled COMPRESSIBLE ADJUNCTWITH CROSSING SPACER FIBERS, filed Dec. 21, 2018, which issued on Mar.2, 2021 as U.S. Pat. No. 10,932,779, which is a continuation applicationclaiming priority under 35 U.S.C. § 120 to U.S. patent application Ser.No. 14/871,071, entitled COMPRESSIBLE ADJUNCT WITH CROSSING SPACERFIBERS, filed Sep. 30, 2015, which issued on Oct. 8, 2019 as U.S. Pat.No. 10,433,846, the entire disclosures of which are hereby incorporatedby reference herein.

BACKGROUND

The present invention relates to surgical instruments and, in variousarrangements, to surgical stapling and cutting instruments and staplecartridges for use therewith that are designed to staple and cut tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The features of the various embodiments are set forth with particularityin the appended claims. The various embodiments, however, both as toorganization and methods of operation, together with advantages thereof,may best be understood by reference to the following description, takenin conjunction with the accompanying drawings as follows:

FIG. 1 is a perspective view of a surgical stapling and severinginstrument comprising a handle, a shaft extending from the handle, andan end effector extending including an anvil and a staple cartridge;

FIG. 2 is a perspective view of a wedge sled of a staple cartridge ofthe surgical stapling and severing instrument of FIG. 1 ;

FIG. 3 is a perspective view of a two-piece knife and firing bar(“E-beam”) of the surgical stapling and severing instrument of FIG. 1 ;

FIG. 4 is a longitudinal cross-sectional view of an anvil in a closedposition, a staple cartridge comprising a rigid support portion, and acompressible adjunct illustrated with staples being moved from anunfired position to a fired position during a firing sequence;

FIG. 5 is another cross-sectional view of the anvil and the staplecartridge of FIG. 4 illustrating the anvil in an open position after thefiring sequence has been completed;

FIG. 6 is a partial perspective view of a staple cartridge assemblycomprising a compressible adjunct in accordance with at least oneembodiment;

FIG. 6A is a partial perspective view of the adjunct of FIG. 6 implantedagainst tissue by at least one staple;

FIG. 6B is a partial perspective view of an alternative compressibleadjunct implanted against tissue by at least one staple in accordancewith at least one embodiment;

FIG. 7 is a partial perspective view of a staple cartridge assemblycomprising an alternative compressible adjunct in accordance with atleast one embodiment;

FIG. 8 is a partial perspective view of a staple cartridge assemblycomprising an alternative compressible adjunct in accordance with atleast one embodiment;

FIG. 9 is a partial perspective view of an alternative compressibleadjunct implanted against tissue by at least one staple in accordancewith at least one embodiment;

FIG. 10 is a partial cross-sectional view of a staple cartridge assemblycomprising an alternative compressible adjunct in accordance with atleast one embodiment;

FIG. 11 is a partial cross-sectional view of a staple cartridge assemblycomprising an alternative compressible adjunct in accordance with atleast one embodiment;

FIG. 12 is a partial cross-sectional view of a staple cartridge assemblycomprising an alternative compressible adjunct in accordance with atleast one embodiment;

FIG. 13 is a partial perspective view of an alternative compressibleadjunct in accordance with at least one embodiment;

FIG. 14 is a perspective view of the compressible adjunct of FIG. 13positioned against a cartridge deck of a staple cartridge;

FIG. 15 is a perspective view of a staple cartridge assembly comprisingan alternative compressible adjunct in accordance with at least oneembodiment;

FIG. 16 is a partial perspective view of an alternative compressibleadjunct in accordance with at least one embodiment;

FIG. 17 is a partial perspective view of a compressible adjunct inaccordance with at least one embodiment;

FIG. 18 is a cross-sectional view of the compressible adjunct of FIG. 17;

FIG. 19 is a detailed view of the cross-sectional view of FIG. 18 ;

FIG. 20 is a perspective view of a staple cartridge assembly comprisinga compressible adjunct in accordance with at least one embodiment;

FIG. 21 is a different perspective view of the staple cartridge assemblyof FIG. 20 ;

FIG. 22 is a different perspective view of the staple cartridge assemblyof FIG. 20 ;

FIG. 23 is a partial perspective view of a compressible adjunct inaccordance with at least one embodiment;

FIG. 24 is a partial cross-sectional view of a staple cartridge assemblyin accordance with at least one embodiment;

FIG. 25 is a partial cross-sectional view of a securing member insertedinto a staple cavity of a staple cartridge in accordance with at leastone embodiment;

FIG. 26 is a partial cross-sectional view of a compressible adjunct inaccordance with at least one embodiment;

FIG. 27 is a partial cross-sectional view of a compressible adjunct inaccordance with at least one embodiment;

FIG. 28 is a partial perspective view of an alternative compressibleadjunct implanted against tissue by at least one staple in accordancewith at least one embodiment;

FIG. 29 is a partial cross-sectional view of the compressible adjunct ofFIG. 28 without compression;

FIG. 30 is the partial cross-sectional view of FIG. 29 undercompression;

FIG. 31 is a perspective view of a staple cartridge assembly comprisingan alternative compressible adjunct in accordance with at least oneembodiment;

FIG. 32 is a perspective view of a staple cartridge assembly comprisingan alternative compressible adjunct in accordance with at least oneembodiment;

FIG. 33 is a partial perspective view of a staple cartridge assemblycomprising an implantable adjunct in accordance with at least oneembodiment;

FIG. 34 is a partial perspective view of the adjunct of FIG. 33implanted against tissue by at least one staple;

FIG. 35 is a partial perspective view of an implantable adjunct inaccordance with at least one embodiment;

FIG. 36 is a partial perspective view of an implantable adjunct inaccordance with at least one alternative embodiment;

FIG. 37 is a partial elevational view of the implantable adjunct of FIG.36 ;

FIG. 38A is a detail view of a loop knot in accordance with at least oneembodiment;

FIG. 38B is a detail view of a loop knot utilized by the adjunct of FIG.35 in accordance with at least one embodiment;

FIG. 39 is a partial elevational view of the implantable adjunct of FIG.35 ;

FIG. 40 is a partial cross-sectional view of a compressible adjunctincluding a plurality of standing fibers in accordance with at least oneembodiment described herein;

FIG. 41 is a partial cross-sectional view of a compressible adjunctincluding a plurality of standing fibers in accordance with at least oneembodiment described herein;

FIG. 42 is a partial perspective view of a compressible adjunctimplanted against tissue by at least one staple in accordance with atleast one embodiment described herein;

FIG. 43 is a partial perspective view of a fiber in accordance with atleast one embodiment described herein;

FIG. 44 is a partial perspective view of a fiber in accordance with atleast one embodiment described herein; and

FIG. 45 is a partial perspective view of a compressible adjunct inaccordance with at least one embodiment described herein.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate various embodiments of the invention, in one form, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

The Applicant of the present application owns the following U.S. patentapplications that were filed on Sep. 30, 2015 and which are each hereinincorporated by reference in their respective entireties:

U.S. patent application Ser. No. 14/871,036, entitled IMPLANTABLE LAYERCOMPRISING PLASTICALLY DEFORMED FIBERS, now U.S. Pat. No. 10,327,777;

U.S. patent application Ser. No. 14/871,056, entitled IMPLANTABLE LAYERCOMPRISING A CONSTRICTED CONFIGURATION, now U.S. Pat. No. 10,478,188;

U.S. patent application Ser. No. 14/871,078, entitled TUBULAR ABSORBABLECONSTRUCTS, now U.S. Pat. No. 10,561,420;

U.S. patent application Ser. No. 14/871,087, entitled IMPLANTABLEADJUNCT COMPRISING BONDED LAYERS, now U.S. Patent ApplicationPublication No. 2017/0086838;

U.S. patent application Ser. No. 14/871,107, entitled COMPRESSIBLEADJUNCTS WITH BONDING NODES, now U.S. Pat. No. 10,172,620;

U.S. patent application Ser. No. 14/871,057, entitled COMPRESSIBLEADJUNCT WITH INTERMEDIATE SUPPORTING STRUCTURES, now U.S. PatentApplication Publication No. 2017/0086829;

U.S. patent application Ser. No. 14/871,083, entitled COMPRESSIBLEADJUNCT WITH LOOPING MEMBERS, now U.S. Pat. No. 10,736,633;

U.S. patent application Ser. No. 14/871,089, entitled WOVEN CONSTRUCTSWITH INTERLOCKED STANDING FIBERS, now U.S. Pat. No. 10,271,849;

U.S. patent application Ser. No. 14/871,119, entitled COMPRESSIBLEADJUNCT AND METHODS FOR MAKING THE SAME, now U.S. Pat. No. 10,285,699;

U.S. patent application Ser. No. 14/871,131, entitled METHOD FORAPPLYING AN IMPLANTABLE LAYER TO A FASTENER CARTRIDGE, now U.S. PatentApplication Publication No. 2017/0086842;

U.S. patent application Ser. No. 14/871,153, entitled COMPRESSIBLEADJUNCT WITH ATTACHMENT REGIONS, now U.S. Pat. No. 10,524,788;

U.S. patent application Ser. No. 14/871,176, entitled PROGRESSIVELYRELEASABLE IMPLANTABLE ADJUNCT FOR USE WITH A SURGICAL STAPLINGINSTRUMENT, now U.S. Pat. No. 10,603,039; and

U.S. patent application Ser. No. 14/871,195, entitled COMPRESSIBLEADJUNCT ASSEMBLIES WITH ATTACHMENT LAYERS, now U.S. Pat. No. 10,307,160.

The Applicant of the present application also owns the U.S. patentapplications identified below which are each herein incorporated byreference in their respective entireties:

U.S. patent application Ser. No. 12/894,311, entitled SURGICALINSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS, now U.S. Pat. No.8,763,877;

U.S. patent application Ser. No. 12/894,340, entitled SURGICAL STAPLECARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICALSTAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS, now U.S. Pat.No. 8,899,463;

U.S. patent application Ser. No. 12/894,327, entitled JAW CLOSUREARRANGEMENTS FOR SURGICAL INSTRUMENTS, now U.S. Pat. No. 8,978,956;

U.S. patent application Ser. No. 12/894,351, entitled SURGICAL CUTTINGAND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENTAND TISSUE CUTTING SYSTEMS, now U.S. Pat. No. 9,113,864;

U.S. patent application Ser. No. 12/894,338, entitled IMPLANTABLEFASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT, now U.S. Pat. No.8,864,007;

U.S. patent application Ser. No. 12/894,369, entitled IMPLANTABLEFASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER, now U.S. PatentApplication Publication No. 2012/0080344;

U.S. patent application Ser. No. 12/894,312, entitled IMPLANTABLEFASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS, now U.S. Pat. No.8,925,782;

U.S. patent application Ser. No. 12/894,377, entitled SELECTIVELYORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, now U.S. Pat. No. 8,393,514;

U.S. patent application Ser. No. 12/894,339, entitled SURGICAL STAPLINGINSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT, now U.S. Pat.No. 8,840,003;

U.S. patent application Ser. No. 12/894,360, entitled SURGICAL STAPLINGINSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM, now U.S. Pat. No.9,113,862;

U.S. patent application Ser. No. 12/894,322, entitled SURGICAL STAPLINGINSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS, now U.S.Pat. No. 8,740,034;

U.S. patent application Ser. No. 12/894,350, entitled SURGICAL STAPLECARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES, now U.S. PatentApplication Publication No. 2012/0080478;

U.S. patent application Ser. No. 12/894,383, entitled IMPLANTABLEFASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS, now U.S. Pat. No.8,752,699;

U.S. patent application Ser. No. 12/894,389, entitled COMPRESSIBLEFASTENER CARTRIDGE, now U.S. Pat. No. 8,740,037;

U.S. patent application Ser. No. 12/894,345, entitled FASTENERSSUPPORTED BY A FASTENER CARTRIDGE SUPPORT, now U.S. Pat. No. 8,783,542;

U.S. patent application Ser. No. 12/894,306, entitled COLLAPSIBLEFASTENER CARTRIDGE, now U.S. Pat. No. 9,044,227;

U.S. patent application Ser. No. 12/894,318, entitled FASTENER SYSTEMCOMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS, now U.S.Pat. No. 8,814,024;

U.S. patent application Ser. No. 12/894,330, entitled FASTENER SYSTEMCOMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX, now U.S. Pat. No.8,757,465;

U.S. patent application Ser. No. 12/894,361, entitled FASTENER SYSTEMCOMPRISING A RETENTION MATRIX, now U.S. Pat. No. 8,529,600;

U.S. patent application Ser. No. 12/894,367, entitled FASTENINGINSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTIONMATRIX, now U.S. Pat. No. 9,033,203;

U.S. patent application Ser. No. 12/894,388, entitled FASTENER SYSTEMCOMPRISING A RETENTION MATRIX AND A COVER, now U.S. Pat. No. 8,474,677;

U.S. patent application Ser. No. 12/894,376, entitled FASTENER SYSTEMCOMPRISING A PLURALITY OF FASTENER CARTRIDGES, now U.S. Pat. No.9,044,228;

U.S. patent application Ser. No. 13/097,865, entitled SURGICAL STAPLERANVIL COMPRISING A PLURALITY OF FORMING POCKETS, now U.S. Pat. No.9,295,464;

U.S. patent application Ser. No. 13/097,936, entitled TISSUE THICKNESSCOMPENSATOR FOR A SURGICAL STAPLER, now U.S. Pat. No. 8,657,176;

U.S. patent application Ser. No. 13/097,954, entitled STAPLE CARTRIDGECOMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION, now U.S. Pat. No.10,136,890;

U.S. patent application Ser. No. 13/097,856, entitled STAPLE CARTRIDGECOMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF, nowU.S. Patent Application Publication No. 2012/0080336;

U.S. patent application Ser. No. 13/097,928, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING DETACHABLE PORTIONS, now U.S. Pat. No. 8,746,535;

U.S. patent application Ser. No. 13/097,891, entitled TISSUE THICKNESSCOMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL, nowU.S. Pat. No. 8,864,009;

U.S. patent application Ser. No. 13/097,948, entitled STAPLE CARTRIDGECOMPRISING AN ADJUSTABLE DISTAL PORTION, now U.S. Pat. No. 8,978,954;

U.S. patent application Ser. No. 13/097,907, entitled COMPRESSIBLESTAPLE CARTRIDGE ASSEMBLY, now U.S. Pat. No. 9,301,755;

U.S. patent application Ser. No. 13/097,861, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES, now U.S.Pat. No. 9,113,865;

U.S. patent application Ser. No. 13/097,869, entitled STAPLE CARTRIDGELOADING ASSEMBLY, now U.S. Pat. No. 8,857,694;

U.S. patent application Ser. No. 13/097,917, entitled COMPRESSIBLESTAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS, now U.S. Pat. No.8,777,004;

U.S. patent application Ser. No. 13/097,873, entitled STAPLE CARTRIDGECOMPRISING A RELEASABLE PORTION, now U.S. Pat. No. 8,740,038;

U.S. patent application Ser. No. 13/097,938, entitled STAPLE CARTRIDGECOMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS, now U.S. Pat.No. 9,016,542;

U.S. patent application Ser. No. 13/097,924, entitled STAPLE CARTRIDGECOMPRISING A TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No. 9,168,038;

U.S. patent application Ser. No. 13/242,029, entitled SURGICAL STAPLERWITH FLOATING ANVIL, now U.S. Pat. No. 8,893,949;

U.S. patent application Ser. No. 13/242,066, entitled CURVED ENDEFFECTOR FOR A STAPLING INSTRUMENT, now U.S. Patent ApplicationPublication No. 2012/0080498;

U.S. patent application Ser. No. 13/242,086, entitled STAPLE CARTRIDGEINCLUDING COLLAPSIBLE DECK, now U.S. Pat. No. 9,055,941;

U.S. patent application Ser. No. 13/241,912, entitled STAPLE CARTRIDGEINCLUDING COLLAPSIBLE DECK ARRANGEMENT, now U.S. Pat. No. 9,050,084;

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U.S. patent application Ser. No. 13/241,637, entitled SURGICALINSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATIONMOTIONS, now U.S. Pat. No. 8,789,741;

U.S. patent application Ser. No. 13/241,629, entitled SURGICALINSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR, now U.S. PatentApplication Publication No. 2012/0074200;

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U.S. patent application Ser. No. 13/433,103, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING A PLURALITY OF LAYERS, now U.S. Pat. No.9,433,419;

U.S. patent application Ser. No. 13/433,098, entitled EXPANDABLE TISSUETHICKNESS COMPENSATOR, now U.S. Pat. No. 9,301,753;

U.S. patent application Ser. No. 13/433,102, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING A RESERVOIR, now U.S. Pat. No. 9,232,941;

U.S. patent application Ser. No. 13/433,114, entitled RETAINER ASSEMBLYINCLUDING A TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No. 9,386,988;

U.S. patent application Ser. No. 13/433,136, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT, now U.S. Pat. No.9,839,420;

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U.S. patent application Ser. No. 13/433,144, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD, now U.S. Pat.No. 9,277,919;

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U.S. patent application Ser. No. 13/763,078, entitled ANVIL LAYERATTACHED TO A PROXIMAL END OF AN END EFFECTOR, now U.S. Pat. No.9,848,875;

U.S. patent application Ser. No. 13/763,094, entitled LAYER COMPRISINGDEPLOYABLE ATTACHMENT MEMBERS, now U.S. Pat. No. 9,788,834;

U.S. patent application Ser. No. 13/763,106, entitled END EFFECTORCOMPRISING A DISTAL TISSUE ABUTMENT MEMBER, now U.S. Pat. No. 9,592,050;

U.S. patent application Ser. No. 13/433,147, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING CHANNELS, now U.S. Pat. No. 9,351,730;

U.S. patent application Ser. No. 13/763,112, entitled SURGICAL STAPLINGCARTRIDGE WITH LAYER RETENTION FEATURES, now U.S. Pat. No. 10,405,854;

U.S. patent application Ser. No. 13/763,035, entitled ACTUATOR FORRELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE, nowU.S. Pat. No. 10,213,198;

U.S. patent application Ser. No. 13/763,042, entitled RELEASABLE TISSUETHICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME, now U.S.Pat. No. 9,861,361;

U.S. patent application Ser. No. 13/763,048, entitled FASTENER CARTRIDGECOMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR, now U.S. Pat. No.9,700,317;

U.S. patent application Ser. No. 13/763,054, entitled FASTENER CARTRIDGECOMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESSCOMPENSATOR, now U.S. Pat. No. 9,272,406;

U.S. patent application Ser. No. 13/763,065, entitled FASTENER CARTRIDGECOMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR, now U.S.Pat. No. 9,566,061;

U.S. patent application Ser. No. 13/763,021, entitled STAPLE CARTRIDGECOMPRISING A RELEASABLE COVER, now U.S. Pat. No. 9,386,984;

U.S. patent application Ser. No. 13/763,078, entitled ANVIL LAYERATTACHED TO A PROXIMAL END OF AN END EFFECTOR, now U.S. Pat. No.9,848,875;

U.S. patent application Ser. No. 13/763,095, entitled LAYER ARRANGEMENTSFOR SURGICAL STAPLE CARTRIDGES, now U.S. Pat. No. 9,770,245;

U.S. patent application Ser. No. 13/763,147, entitled IMPLANTABLEARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES, now U.S. Pat. No.10,390,823;

U.S. patent application Ser. No. 13/763,192, entitled MULTIPLE THICKNESSIMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES, now U.S. Pat. No.9,615,826;

U.S. patent application Ser. No. 13/763,161, entitled RELEASABLE LAYEROF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME, now U.S. PatentApplication Publication No. 2013/0153641;

U.S. patent application Ser. No. 13/763,177, entitled ACTUATOR FORRELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR, now U.S.Pat. No. 9,585,657;

U.S. patent application Ser. No. 13/763,037, entitled STAPLE CARTRIDGECOMPRISING A COMPRESSIBLE PORTION, now U.S. Patent ApplicationPublication No. 2014/0224857;

U.S. patent application Ser. No. 13/433,126, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING TISSUE INGROWTH FEATURES, now U.S. Pat. No.9,320,523;

U.S. patent application Ser. No. 13/433,132, entitled DEVICES ANDMETHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TOSURGICAL STAPLING INSTRUMENTS, now U.S. Patent Application PublicationNo. 2013/0256373;

U.S. patent application Ser. No. 13/851,703, entitled FASTENER CARTRIDGECOMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN,now U.S. Pat. No. 9,572,577;

U.S. patent application Ser. No. 13/851,676, entitled TISSUE THICKNESSCOMPENSATOR COMPRISING A CUTTING MEMBER PATH, now U.S. PatentApplication Publication No. 2014/0291379;

U.S. patent application Ser. No. 13/851,693, entitled FASTENER CARTRIDGEASSEMBLIES, now U.S. Pat. No. 9,332,984;

U.S. patent application Ser. No. 13/851,684, entitled FASTENER CARTRIDGECOMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT, nowU.S. Pat. No. 9,795,384;

U.S. patent application Ser. No. 14/187,387, entitled STAPLE CARTRIDGEINCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No.2014/0166724;

U.S. patent application Ser. No. 14/187,395, entitled STAPLE CARTRIDGEINCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No.2014/0166725;

U.S. patent application Ser. No. 14/187,400, entitled STAPLE CARTRIDGEINCLUDING A BARBED STAPLE, now U.S. Patent Application Publication No.2014/0166726;

U.S. patent application Ser. No. 14/187,383, entitled IMPLANTABLE LAYERSAND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICALFASTENING INSTRUMENTS, now U.S. Pat. No. 9,839,422;

U.S. patent application Ser. No. 14/187,386, entitled IMPLANTABLE LAYERSAND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERSFOR USE WITH FASTENING INSTRUMENTS, now U.S. Pat. No. 9,884,456;

U.S. patent application Ser. No. 14/187,390, entitled IMPLANTABLE LAYERSAND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USEWITH A SURGICAL FASTENING INSTRUMENT, now U.S. Pat. No. 9,839,423;

U.S. patent application Ser. No. 14/187,389, entitled IMPLANTABLE LAYERASSEMBLIES, now U.S. Pat. No. 9,757,124;

U.S. patent application Ser. No. 14/187,385, entitled IMPLANTABLE LAYERSCOMPRISING A PRESSED REGION, now U.S. Pat. No. 9,693,777;

U.S. patent application Ser. No. 14/187,384, entitled FASTENING SYSTEMCOMPRISING A FIRING MEMBER LOCKOUT, now U.S. Pat. No. 9,775,608;

U.S. patent application Ser. No. 14/827,856, entitled IMPLANTABLE LAYERSFOR A SURGICAL INSTRUMENT, now U.S. Patent Application Publication No.2017/0049444;

U.S. patent application Ser. No. 14/827,907, entitled IMPLANTABLE LAYERSFOR A SURGICAL INSTRUMENT, now U.S. Pat. No. 10,617,418;

U.S. patent application Ser. No. 14/827,932, entitled IMPLANTABLE LAYERSFOR A SURGICAL INSTRUMENT, now U.S. Patent Application Publication No.2017/0049448;

U.S. patent application Ser. No. 14/667,874, entitled MALLEABLEBIOABSORBABLE POLYMER ADHESIVE FOR RELEASABLY ATTACHING A STAPLEBUTTRESS TO A SURGICAL STAPLER, now U.S. Pat. No. 10,172,617;

U.S. patent application Ser. No. 14/300,954, entitled ADJUNCT MATERIALSAND METHODS OF USING SAME IN SURGICAL METHODS FOR TISSUE SEALING, nowU.S. Pat. No. 10,172,611;

U.S. patent application Ser. No. 14/840,613, entitled DRUG ELUTINGADJUNCTS AND METHODS OF USING DRUG ELUTING ADJUNCTS, now U.S. Pat. No.10,569,071;

U.S. patent application Ser. No. 14/498,145, entitled METHOD FORCREATING A FLEXIBLE STAPLE LINE, now U.S. Pat. No. 10,327,764; and

U.S. patent application Ser. No. 14/865,306, entitled IMPLANTABLEADJUNCT SYSTEMS FOR DETERMINING ADJUNCT SKEW, now U.S. Pat. No.10,299,878.

Numerous specific details are set forth to provide a thoroughunderstanding of the overall structure, function, manufacture, and useof the embodiments as described in the specification and illustrated inthe accompanying drawings. Well-known operations, components, andelements have not been described in detail so as not to obscure theembodiments described in the specification. The reader will understandthat the embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative andillustrative. Variations and changes thereto may be made withoutdeparting from the scope of the claims.

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”) and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, a surgicalsystem, device, or apparatus that “comprises,” “has,” “includes” or“contains” one or more elements possesses those one or more elements,but is not limited to possessing only those one or more elements.Likewise, an element of a system, device, or apparatus that “comprises,”“has,” “includes” or “contains” one or more features possesses those oneor more features, but is not limited to possessing only those one ormore features.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” referring to the portion closest to the clinicianand the term “distal” referring to the portion located away from theclinician. It will be further appreciated that, for convenience andclarity, spatial terms such as “vertical”, “horizontal”, “up”, and“down” may be used herein with respect to the drawings. However,surgical instruments are used in many orientations and positions, andthese terms are not intended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performinglaparoscopic and minimally invasive surgical procedures. However, thereader will readily appreciate that the various methods and devicesdisclosed herein can be used in numerous surgical procedures andapplications including, for example, in connection with open surgicalprocedures. As the present Detailed Description proceeds, the readerwill further appreciate that the various instruments disclosed hereincan be inserted into a body in any way, such as through a naturalorifice, through an incision or puncture hole formed in tissue, etc. Theworking portions or end effector portions of the instruments can beinserted directly into a patient's body or can be inserted through anaccess device that has a working channel through which an end effectorand elongated shaft of a surgical instrument can be advanced.

A surgical stapling system can comprise a shaft and an end effectorextending from the shaft. The end effector comprises a first jaw and asecond jaw. The first jaw comprises a staple cartridge. The staplecartridge is insertable into and removable from the first jaw; however,other embodiments are envisioned in which a staple cartridge is notremovable from, or at least readily replaceable from, the first jaw. Thesecond jaw comprises an anvil configured to deform staples ejected fromthe staple cartridge. The second jaw is pivotable relative to the firstjaw about a closure axis; however, other embodiments are envisioned inwhich the first jaw is pivotable relative to the second jaw. Thesurgical stapling system further comprises an articulation jointconfigured to permit the end effector to be rotated, or articulated,relative to the shaft. The end effector is rotatable about anarticulation axis extending through the articulation joint. Otherembodiments are envisioned which do not include an articulation joint.

The staple cartridge comprises a cartridge body. The cartridge bodyincludes a proximal end, a distal end, and a deck extending between theproximal end and the distal end. In use, the staple cartridge ispositioned on a first side of the tissue to be stapled and the anvil ispositioned on a second side of the tissue. The anvil is moved toward thestaple cartridge to compress and clamp the tissue against the deck.Thereafter, staples removably stored in the cartridge body can bedeployed into the tissue. The cartridge body includes staple cavitiesdefined therein wherein staples are removably stored in the staplecavities. The staple cavities are arranged in six longitudinal rows.Three rows of staple cavities are positioned on a first side of alongitudinal slot and three rows of staple cavities are positioned on asecond side of the longitudinal slot. Other arrangements of staplecavities and staples may be possible.

The staples are supported by staple drivers in the cartridge body. Thedrivers are movable between a first, or unfired position, and a second,or fired, position to eject the staples from the staple cavities. Thedrivers are retained in the cartridge body by a retainer which extendsaround the bottom of the cartridge body and includes resilient membersconfigured to grip the cartridge body and hold the retainer to thecartridge body. The drivers are movable between their unfired positionsand their fired positions by a sled. The sled is movable between aproximal position adjacent the proximal end and a distal positionadjacent the distal end. The sled comprises a plurality of rampedsurfaces configured to slide under the drivers and lift the drivers, andthe staples supported thereon, toward the anvil.

Further to the above, the sled is moved distally by a firing member. Thefiring member is configured to contact the sled and push the sled towardthe distal end. The longitudinal slot defined in the cartridge body isconfigured to receive the firing member. The anvil also includes a slotconfigured to receive the firing member. The firing member furthercomprises a first cam which engages the first jaw and a second cam whichengages the second jaw. As the firing member is advanced distally, thefirst cam and the second cam can control the distance, or tissue gap,between the deck of the staple cartridge and the anvil. The firingmember also comprises a knife configured to incise the tissue capturedintermediate the staple cartridge and the anvil. It is desirable for theknife to be positioned at least partially proximal to the rampedsurfaces such that the staples are ejected ahead of the knife.

The staple cartridge can also include an implantable layer. Theimplantable layer is configured to be captured within a staple alongwith tissue when the staple is deployed by the corresponding driver. Theimplantable layer can comprise a buttress, a tissue thicknesscompensator, and/or other adjunct material. A tissue thicknesscompensator is configured to compensate for variations in tissueproperties, such as variations in the thickness of tissue, for example,along a staple line. A tissue thickness compensator can be compressibleand resilient. In use, a tissue thickness compensator prevents or limitsthe over-compression of stapled tissue while facilitating adequatetissue compression within and between staples.

The implantable layer of a staple cartridge can be releasably secured tothe body of the staple cartridge. For example, the implantable layer canbe releasably secured to the deck of the staple cartridge with areleasable adhesive, at least one attachment tab, and/or otherattachment features. Additionally or alternatively, an implantable layercan be releasably secured to the first jaw or the second jaw. Animplantable layer can be positioned on the cartridge-side of an endeffector and/or the anvil-side of the end effector, for example.

An implantable layer can be configured to promote tissue ingrowth. Invarious instances, it is desirable to promote the ingrowth of tissueinto an implantable layer to promote the healing of the treated tissue(e.g. stapled and/or incised tissue) and/or to accelerate the patient'srecovery. More specifically, the ingrowth of tissue into an implantablelayer may reduce the incidence, extent, and/or duration of inflammationat the surgical site. Tissue ingrowth into and/or around the implantablelayer may manage the spread of infections at the surgical site, forexample. The ingrowth of blood vessels, especially white blood cells,for example, into and/or around the implantable layer may fightinfections in and/or around the implantable layer and the adjacenttissue. Tissue ingrowth may also encourage the acceptance of foreignmatter (e.g. the implantable layer and the staples) by the patient'sbody and may reduce the likelihood of the patient's body rejecting theforeign matter. Rejection of foreign matter may cause infection and/orinflammation at the surgical site.

Turning to the Drawings wherein like numerals denote like componentsthroughout the several views, FIG. 1 illustrates an exemplary surgicalstapling and severing instrument 8010 suitable for use with animplantable adjunct such as, for example, a tissue thicknesscompensator. The surgical stapling and severing instrument 8010 cancomprise an anvil 8014 which may be repeatedly opened and closed aboutits pivotal attachment to an elongate staple channel 8016. A stapleapplying assembly 8012 may comprise the anvil 8014 and the channel 8016,wherein the assembly 8012 can be proximally attached to an elongateshaft 8018 forming an implement portion 8022. When the staple applyingassembly 8012 is closed, or at least substantially closed, the implementportion 8022 can present a sufficiently small cross-section suitable forinserting the staple applying assembly 8012 through a trocar.

In various circumstances, the staple cartridge assembly 8012 ismanipulated by a handle 8020 connected to the elongate shaft 8018. Thehandle 8020 can comprise user controls such as a rotation knob 8030 thatrotates the elongate shaft 8018 and the staple applying assembly 8012about a longitudinal axis of the shaft 8018 and a closure trigger 8026,which can pivot in front of a pistol grip 8036 to close the stapleapplying assembly 8012. A closure release button 8038 is outwardlypresented on the handle 8020 when the closure trigger 8026 is clampedsuch that the release button 8038 can be depressed to unclamp theclosure trigger 8026 and open the staple applying assembly 8012, forexample.

A firing trigger 8034, which can pivot in front of the closure trigger8026, causes the staple applying assembly 8012 to simultaneously severand staple tissue clamped therein. In various circumstances, multiplefiring strokes can be employed using the firing trigger 8034 to reducethe amount of force required to be applied by the surgeon's hand perstroke. In certain embodiments, the handle 8020 can comprise one or morerotatable indicator wheels such as, for example, rotatable indicatorwheel 8041 which can indicate the firing progress. A manual firingrelease lever 8042 can allow the firing system to be retracted beforefull firing travel has been completed, if desired, and, in addition, thefiring release lever 8042 can allow a surgeon, or other clinician, toretract the firing system in the event that the firing system bindsand/or fails.

Additional details on the surgical stapling and severing instrument 8010and other surgical stapling and severing instruments suitable for usewith the present disclosure are described, for example, in U.S. patentapplication Ser. No. 13/851,693, entitled FASTENER CARTRIDGE ASSEMBLY,and filed on Mar. 27, 2013, now U.S. Pat. No. 9,332,984, the entiredisclosure of which is incorporated herein by reference. Furthermore,powered surgical stapling and severing instruments can also be utilizedwith the present disclosure. See, for example, U.S. Patent ApplicationPublication No. 2009/0090763, entitled POWERED SURGICAL STAPLING DEVICE,and filed on Aug. 12, 2008, the entire disclosure of which isincorporated herein by reference.

With reference to FIGS. 2 and 3 , a firing assembly such as, forexample, firing assembly 9090 can be utilized with the surgical staplingand severing instrument 8010 to advance a wedge sled 9126 whichcomprises a plurality of wedges 9204 configured to deploy staples fromthe staple applying assembly 8012 into tissue captured between the anvil8014 and the elongate staple channel 8016. Furthermore, an E-beam 9102at a distal portion of the firing assembly 9090 may fire the stales fromthe staple applying assembly 8012 as well as position the anvil 8014relative to the elongate staple channel 8016 during firing. The E-beam9102 includes a pair of top pins 9110, a pair of middle pins 9112 whichmay follow portion 9218 of the wedge sled 9126, and a bottom pin or foot9114, as well as a sharp cutting edge 9116 which can be configured tosever the captured tissue as the firing assembly 9090 is advanceddistally. In addition, integrally formed and proximally projecting topguide 9118 and middle guide 9120 bracketing each vertical end of thecutting edge 9116 may further define a tissue staging area 9122assisting in guiding tissue to the sharp cutting edge 9116 prior tobeing severed. The middle guide 9120 may also serve to engage and firethe staple applying assembly 8012 by abutting a stepped central member9124 of the wedge sled 9126 (FIG. 2 ) that effects staple formation bythe staple applying assembly 8012.

In various circumstances, a staple cartridge can comprise means forcompensating for the thickness of tissue captured within staplesdeployed from a staple cartridge. Referring to FIG. 4 , a staplecartridge, such as staple cartridge 10000, for example, can be utilizedwith the surgical stapling and severing instrument 8010 and can includea rigid first portion, such as support portion 10010, for example, and acompressible second portion, such as tissue thickness compensator 10020,for example. The support portion 10010 can comprise a cartridge body anda plurality of staple cavities 10012. A staple 10030, for example, canbe removably positioned in each staple cavity 10012. Referring primarilyto FIGS. 4 and 5 , each staple 10030 can comprise a base 10031 and oneor more legs 10032 extending from the base 10031. Prior to the staples10030 being deployed, the bases 10031 of the staples 10030 can besupported by staple drivers positioned within the support portion 10010and, concurrently, the legs 10032 of the staples 10030 can be at leastpartially contained within the staple cavities 10012.

In various circumstances, the staples 10030 can be deployed between anunfired position and a fired position such that the legs 10032 movethrough the tissue thickness compensator 10020, penetrate through a topsurface of the tissue thickness compensator 10020, penetrate the tissueT, and contact an anvil positioned opposite the staple cartridge 10000.As the legs 10032 are deformed against the anvil, the legs 10032 of eachstaple 10030 can capture a portion of the tissue thickness compensator10020 and a portion of the tissue T within each staple 10030 and apply acompressive force to the tissue. Further to the above, the legs 10032 ofeach staple 10030 can be deformed downwardly toward the base 10031 ofthe staple to form a staple entrapment area in which the tissue T andthe tissue thickness compensator 10020 can be captured. In variouscircumstances, the staple entrapment area can be defined between theinner surfaces of the deformed legs 10032 and the inner surface of thebase 10031. The size of the entrapment area for a staple can depend onseveral factors such as the length of the legs, the diameter of thelegs, the width of the base, and/or the extent in which the legs aredeformed, for example.

In use, further to the above and referring primarily to FIG. 4 , ananvil, such as anvil 8014 of the surgical stapling and severinginstrument 8010, can be moved into a closed position opposite the staplecartridge 10000 by depressing the closure trigger 8026 to advance theE-beam 9102. The anvil 8014 can position tissue against the tissuethickness compensator 10020 and, in various circumstances, compress thetissue thickness compensator 10020 against the support portion 10010,for example. Once the anvil 8014 has been suitably positioned, thestaples 10030 can be deployed, as also illustrated in FIG. 4 .

In various circumstances, as mentioned above, a staple-firing sled10050, which is similar in many respects to the sled 9126 (See FIG. 3 ),can be moved from a proximal end of the staple cartridge 10000 toward adistal end 10002, as illustrated in FIG. 5 . As the firing assembly 9090is advanced, the sled 10050 can contact the staple drivers 10040 andlift the staple drivers 10040 upwardly within the staple cavities 10012.In at least one example, the sled 10050 and the staple drivers 10040 caneach comprise one or more ramps, or inclined surfaces, which canco-operate to move the staple drivers 10040 upwardly from their unfiredpositions. As the staple drivers 10040 are lifted upwardly within theirrespective staple cavities 10012, the staple drivers 10040 can lift thestaples 10030 upwardly such that the staples 10030 can emerge from theirstaple cavities 10012. In various circumstances, the sled 10050 can moveseveral staples upwardly at the same time as part of a firing sequence.

Referring to FIG. 5 , the staple legs 10032 of the staples 10030 canextend into the compensator 10020 beyond the support portion 10010 whenthe staples 10030 are in their unfired positions. In variouscircumstances, the tips of the staple legs 10032, or any other portionof the staple legs 10032, may not protrude through a toptissue-contacting surface 10021 of the tissue thickness compensator10020 when the staples 10030 are in their unfired positions. In certaincircumstances, the tips of the staple legs 10032 can comprise sharp tipswhich can incise and penetrate the tissue thickness compensator 10020.

Referring to FIG. 6 , a staple cartridge assembly 10 is illustrated. Thestaple cartridge assembly 10 includes a staple cartridge 12 which can beused with the surgical stapling and severing instrument 8010. The staplecartridge 12 is similar in many respects to the staple cartridge 10000.Like the staple cartridge 10000, the staple cartridge 12 includes aplurality of staples 10030 which are housed in a plurality of cavitiesor pockets defined in the staple cartridge 12. Also, the plurality ofstaples 10030 of the staple cartridge 12 can be deployed in a firingsequence of the surgical stapling and severing instrument 8010.

The staple cartridge 12 further includes a cartridge deck 16 and a knifeslot 37 (FIGS. 14 and 16 ) that accommodates the cutting edge 9116 as itis advanced to cut tissue captured by the surgical stapling and severinginstrument 8010. Advancement of the sled 10050 through the staplecartridge 12 causes the staples 10030 of staple cartridge 12 to bedeployed from their respective pockets into tissue in the same, orsubstantially the same, manner that the staples 10030 are deployed fromthe staple cartridge 10000, as described above.

Referring again to FIG. 6 , the staple cartridge assembly 10 furtherincludes a tissue thickness compensator or compressible adjunct 11 whichis similar in many respects to the tissue thickness compensator 10020.The compressible adjunct 11 is positioned against the cartridge deck 16.The compressible adjunct 11 is attached to the cartridge deck 16. Forexample, the compressible adjunct 11 can be partially melted onto thecartridge deck 16 then resolidified by cooling which causes thecompressible adjunct 11 to bond to the cartridge deck 16. Variousattachment features can also be employed to attach the compressibleadjunct 11 to the cartridge deck 16.

The compressible adjunct 11 includes a first biocompatible layer 14which is configured to be positioned against and/or attached to thecartridge deck 16 and, in addition, a second biocompatible layer 15which is configured to be positioned against tissue captured between theanvil 8014 and the staple cartridge 12. The first biocompatible layer 14and the second biocompatible layer 15 are spaced apart by a plurality ofsupporting members or pillars 19 extending or standing between the firstbiocompatible layer 14 and the second biocompatible layer 15, asillustrated in FIG. 6 . The pillars 19 maintain an average distancebetween the first biocompatible layer 14 and the second biocompatiblelayer 15 defined in part by an average height (H) of the pillars 19.

As illustrated in FIG. 6 , the pillars 19 have the same, or at leastsubstantially the same, height (H). Alternatively, in certain instances,the pillars 19 may have different heights. Furthermore, as illustratedin FIG. 6 , the pillars 19 have the same, or at least substantially thesame, transverse cross-sectional area. Alternatively, the pillars 19 mayhave different transverse cross-sectional areas. In at least oneinstance, the transverse cross-sectional areas of a pillar 19 may varyalong the height (H) of the pillar 19. For example, a pillar 19 may havea wide intermediate section and narrow end sections. Alternatively, apillar 19 may have a narrow intermediate section and wide end sections.Alternatively, a pillar 19 may have a wide intermediate section, onewide end section, and one narrow end section. Alternatively, a pillar 19may have a narrow intermediate section, one narrow end section, and onewide end section.

As illustrated in FIG. 6 , the pillars 19 have circular, or at leastsubstantially circular, transverse cross-sectional areas. Alternatively,one or more of the pillars 19 may have non-circular transversecross-sectional areas. In at least one example, one or more of thepillars 19 may have an oval-shaped, a clover-shaped, a crescent-shaped,or a triangular-shaped transverse cross-sectional area. Other shapes ofthe transverse cross-sectional areas of the pillars 19 are contemplatedby the present disclosure.

Generally, the material composition, the height, and/or the transversecross-sectional area of a pillar 19 control, at least in part, itsstiffness or ability to bend under compression which, in turn, controls,at least in part, the compressibility of the compressible adjunct 11.Accordingly, the pillars 19 can be configured to tune thecompressibility of the compressible adjunct 11 to one or more desiredvalues. Various sections of a compressible adjunct 11 may have pillars19 with different stiff nesses or compressibilities, for example.

The pillars 19 are bendable under compression applied to thecompressible adjunct 11 as an anvil 8014 is moved into a closed positionopposite the staple cartridge 12. The resilience of the pillars 19permits the compressible adjunct 11 to accommodate tissue (T) withtissue portions having different tissue thicknesses while maintainingthe same, or at least substantially the same, average distance betweenthe anvil 8014 and the staple cartridge 12 during a firing sequence ofthe surgical stapling and severing instrument 8010.

As illustrated in FIG. 6A, a staple 10030 is fired into a compressibleadjunct 11 and tissue (T) comprising a first tissue portion 72 with anaverage tissue thickness (T1) and a second tissue portion 74 with anaverage tissue thickness (T2) greater than the tissue thickness (T1).The fired staple 10030 defines a space therein for accommodating thecaptured compressible adjunct 11 and the captured tissue (T). The spacedefined by the fired staple 10030 is limited, at least in part, by aheight (H3) of the fired staple 10030, as illustrated in FIG. 6A. Thesum of the final thickness of the captured tissue (T) and final heightof the collapsed compressible adjunct 11 is equal, or at leastsubstantially equal, to the height (H3) of the fired staple 10030. Tocompensate for the variability in the thickness of the captured tissue(T), the portion of the compressible adjunct 11 positioned against thesecond tissue portion (T2) is compressed to a final height (H2) which isgreater than a final height (H1) of the portion of the compressibleadjunct 11 positioned against the first tissue portion (T1). Theresilience of the pillars 19 permits the compressible adjunct 11 to becompressed to a greater degree against the second tissue portion 74 thanthe first tissue portion 72, which permits the compressible adjunct 11to compensate for the different thicknesses of the tissue portions 72and 74 within the space defined by the fired staples 10030.

As the anvil 8014 is moved toward its closed position, the anvil 8014can contact tissue T and apply a compressive force to the tissue T andthe compressible adjunct 11. The material composition, porosity,frequency, size, and/or orientation of the pillars 19 can be tailored tocontrol or tune the compressibility of the compressible adjunct 11.

In certain instances, the pillars 19 can be angled or slanted to favoran organized collapse in a first direction such as, for example, aproximal direction (P) in response to the compressive forces. In otherinstances, however, the pillars 19 can be angled or slanted to favor anorganized collapse in a second direction different from the firstdirection such as, for example, a distal direction (D) in response tothe compressive forces. In certain instances, a compressible adjunct 11may include a first group of the pillars 19 that are angled or slantedto favor bending in a first direction and a second group of the pillars19 that are angled or slanted to favor bending in a second directiondifferent from the first direction. In such instances, the differentbending directions may cause the compressible adjunct 11 to bend in adisorganized manner.

Referring to FIG. 6 , the pillars 19 are oriented such that each pillar19 extends, or at least substantially extends, along a transverse axisintersecting the first biocompatible layer 14 and the secondbiocompatible layer 15. The pillars 19 are perpendicular, or at leastsubstantially perpendicular, to the first biocompatible layer 14 and thesecond biocompatible layer 15. Accordingly, the pillars 19 extend inparallel, or at least substantially in parallel, with one another. Asillustrated in FIG. 6 , the pillars 19 are spaced apart from one anotherand are arranged in parallel rows.

In certain instances, the pillars 19 are angled or oriented diagonallywith respect to the first biocompatible layer 14 and/or the secondbiocompatible layer 15. In certain instances, the pillars 19 areorganized in a predefined pattern such as, for example, in concentriccircles. The frequency of the pillars 19 within a certain section of thecompressible adjunct 11 can affect, among other things, thecompressibility of such section. In certain instances, the pillars canbe strategically concentrated in certain sections of the compressibleadjunct 11 to provide greater column strength in such sections, forexample. In at least one instance, the pillars 19 can be concentrated insections of the compressible adjunct 11 that are configured to receivestaples when the surgical stapling and severing instrument 8010 isfired. Alternatively, the pillars 19 can be concentrated in sections ofthe compressible adjunct 11 that do not receive staples when thesurgical stapling and severing instrument 8010 is fired. In certaininstances, the pillars 19 are arranged about an outer perimeter therebydefining side walls of the compressible adjunct 11, as illustrated inFIG. 6 .

Each of the pillars 19 includes an intermediate standing portion 22extending between a first end portion 18 secured to the firstbiocompatible layer 14 and a second end portion 20 secured to the secondbiocompatible layer 15. The end portions 18 and 20 can be embedded intothe first biocompatible layer 14 and the second biocompatible layer 15,respectively. For example, the end portions 18 and 20 can be knitted orwoven into the first biocompatible layer 14 and the second biocompatiblelayer 15, respectively. In certain instances, the end portions 18 and 20can be welded onto the first biocompatible layer 14 and the secondbiocompatible layer 15, respectively, with heat or solvents. In certaininstances, the end portions 18 and 20 can be glued, hooked, an/orfastened to the first biocompatible layer 14 and the secondbiocompatible layer 15, respectively,

As illustrated in FIG. 6 , The first biocompatible layer 14 and thesecond biocompatible layer 15 are woven layers. In certain instances,the first biocompatible layer 14 and/or the second biocompatible layer15 can be knitted layers. In certain instances, the first biocompatiblelayer 14 and/or the second biocompatible layer 15 can be foam layers. Incertain instances, the first biocompatible layer 14 and/or the secondbiocompatible layer 15 can be film layers.

Referring to FIG. 6B, a compressible adjunct 61 is stapled with a tissue(T). The compressible adjunct 61 includes a first biocompatible layer 64which is configured to be positioned against and/or attached to acartridge deck 16 of a staple cartridge 12. Looping members 69 protrudefrom the first biocompatible layer 64. The looping members 69 aredirectly positioned against the tissue captured between an anvil 8014and the staple cartridge 12. Alternatively, the compressible adjunct 61may include a second biocompatible layer is present, and the loopingmembers 69 may maintain an average distance or separation between thebiocompatible layers. In other words, the looping members 69 may lift orraise the second biocompatible layer over the first biocompatible layer64.

The first biocompatible layer 64 and/or the second biocompatible layercan be woven layers. In certain instances, the first biocompatible layer64 and/or the second biocompatible layer can be knitted layers. Incertain instances, the first biocompatible layer 64 and/or the secondbiocompatible layer can be foam layers. In certain instances, the firstbiocompatible layer 64 and/or the second biocompatible layer can be filmlayers. One or more elongate flexible members such as, for example,monofilament and/or multifilament fibers can be used to form one or morelooping members 69 by various techniques such as, for example, weavingand/or knitting. In at least one instance, an elongate flexible membercan be threaded into the first biocompatible layer 64 to form a loopingmember 69, for example.

As illustrated in FIG. 6B, a looping member 69 includes a first endportion 69 a, a second end portion 69 b, and an intermediate curvedportion 69 c that extends between the first end portion 69 a and thesecond end portion 69 b. The end portions 69 a and 69 b are partiallyembedded and/or attached to the first biocompatible layer 64 while theintermediate curved portion 69 c is lifted away or spaced apart from thefirst biocompatible layer 64 by the first end portion 69 a and thesecond end portion 69 b. The looping members 69 may have the same, or atleast substantially the same, height. Alternatively, in certaininstances, the looping members 69 may have different heights.

When the second biocompatible layer is present, the looping members 69can be positioned between the first biocompatible layer 64 and thesecond biocompatible layer, and the intermediate curved portions 69 ccan be attached to the second biocompatible layer, for example. Variousattachment techniques can be employed to secure the second biocompatiblelayer to the intermediate curved portions 69 c such as, for example,using biocompatible glue. In certain instances, the intermediate curvedportions 69 c can be stitched with the second biocompatible layer.

As illustrated in FIG. 6B, the first biocompatible layer 64 comprisestethering islands 62 that are spaced apart from one another. Thetethering islands 62 are arranged in parallel, or at least substantiallyparallel, rows. Each tethering island 62 is defined by a first endportion 69 a and a second end portion 69 b of a looping member 69 thatintersect at that tethering island 62. In certain instances, the endportions 69 a and 69 b of a looping member 69 can be received by twotethering islands 62 that are spaced apart from one another, forexample. In certain instances, only a single end portion 69 a or 69 b isreceived a tethering island 62, for example. Alternatively, a tetheringisland 62 can be configured to receive three or more of the end portions69 a and/or 69 b, for example. A tethering island 62 can be configuredto receive one or more of the end portions 69 a but none of the endportions 69 b, for example.

Further to the above, one or more of the looping members 69 includes anarrow neck portion 63 a extending from a tethering island 62 and a widehead portion 63 b extending from the narrow neck portion 63 a. Incertain instances, the head portions 63 b can be positioned against thesecond biocompatible layer. Alternatively, the head portions 63 b can bepositioned against tissue (T).

As illustrated in FIG. 6B, the looping members 69 protrude from thefirst biocompatible layer 64 in a generally vertical direction, whichcauses the looping members 69 to bend in a disorganized manner inresponse to compressive forces transmitted through tissue (T) that ispositioned against the compressible adjunct 61. In certain instances,the looping members 69 can be angled or slanted to favor an organizedcollapse in a first direction such as, for example, a proximal direction(P) in response to the compressive forces. In other instances, however,the looping members 69 can be angled or slanted to favor an organizedcollapse in a second direction different from the first direction suchas, for example, a distal direction (D) in response to the compressiveforces. In certain instances, a compressible adjunct 61 may include afirst group of the looping members 69 that are angled or slanted tofavor bending in a first direction, and a second group of the loopingmembers 69 that are angled or slanted to favor bending in a seconddirection different from the first direction. In such instances, thedifferent bending directions may cause the compressible adjunct 69 tobend in a disorganized manner.

Referring to FIG. 7 , a compressible adjunct 31 includes a firstbiocompatible layer 34 and a second biocompatible layer 35 that areperforated film layers, as described below in greater detail. Thecompressible adjunct 31 is similar in many respects to the compressibleadjunct 11. For example, the compressible adjunct 31 comprises aplurality of pillars 39 which are similar in many respects to thepillars 19 of the compressible adjunct 11. Unlike the pillars 19, thepillars 39 are not arranged in parallel rows. The pillars 39 areconfigured to cross one another which can improve the stability of thecompressible adjunct 31 by increasing resistance to collapsing undershear loads and/or compressive loads.

As illustrated in FIG. 7 , a pillar 39 a is configured to cross a pillar39 b. A first end portion 38 a of the pillar 39 a is aligned with asecond end portion 40 b of the pillar 39 b such that a first transverseaxis defined by the first end portion 38 a and the second end portion 40b is perpendicular to the biocompatible layer 34 and a secondbiocompatible layer 35. Also, a first end portion 38 b of the pillar 39b is aligned with a second end portion 40 a of the pillar 39 a such thata second transverse axis defined by the first end portion 38 b and thesecond end portion 40 a is perpendicular to the biocompatible layer 34and a second biocompatible layer 35. Furthermore, intermediate portions42 a and 42 b of the pillars 39 a and 39 b, respectively, can beattached to one another such as, for example, by welding. Alternatively,the intermediate portions 42 a and 42 b can be allowed to move freelyrelative to one another.

In a different arrangement, certain pillars 39 can be configured toshare a bonding node or interface. As illustrated in FIG. 7 , a pillar39 c and a pillar 39 d are attached to the first biocompatible layer 34at a bonding node 44. The pillars 39 c and 39 d extend from the bondingnode 44 in different directions terminating at two different bondingnodes 46 and 48 on the second biocompatible layer 35. In addition, apillar 39 e extends from the bonding node 48 terminating at a bondingnode 49 on the first biocompatible layer 34. Repetition of thearrangement of pillars 39 c-39 e between the biocompatible layers 34 and35 can yield a zig-zag pattern therebetween. It should be understoodthat three or more pillars 39 may extend or emerge from one bondingnode.

Further to the above, the perforated films of the biocompatible layers34 and 35 can be produced by punching holes 50 in the films. The holes50 may improve tissue ingrowth into the compressible adjunct 31. Incertain instances, the holes 50 are created after the films areprepared. For example, a solvent or heat can be employed to removesections of the films to create the holes 50. In other instances, thefilms can be prepared with the holes 50 using a mold, for example. Asillustrated in FIG. 7 , the holes 50 are arranged in rows. In addition,the holes 50 of the first biocompatible layer 34 are aligned with theholes 50 of the second biocompatible layer 35 to provide a path for thetissue growth through the compressible adjunct 31. Alternatively, theholes 50 can be randomly positioned. In at least one instance, the holes50 are present in only one of the biocompatible layers 34 and 35.

Referring to FIG. 8 , a compressible adjunct 51 includes a firstbiocompatible layer 54 and a second biocompatible layer 55 that arespaced apart from one another by a plurality of support or standingpillars or fibers 59. The compressible adjunct 51 is similar in manyrespects to the compressible adjuncts 11 and 31. For example, thecompressible adjunct 51 can be positioned against the cartridge deck 16of the staple cartridge 12, as illustrated in FIG. 8 . The compressibleadjunct 51 comprises a weft knitted double fabric. In certain instances,the compressible adjunct 51 comprises two inter-looping sets of fibersthat are configured to yield two tethered layers.

The compressible adjunct 51 includes a plurality of loops 66 running inparallel, or at least substantially in parallel, rows. Each loop 66 ispositioned or starts at one of the biocompatible layers 54 and 55 anddefines two standing fibers 59 that extend toward the other one of thebiocompatible layers 54 and 55. The standing fibers 59 are angled orslanted to favor an organized collapse in a first direction such as, forexample, a proximal direction (P) in response to compressive forcesapplied to the second biocompatible layer 55 through tissue (T)positioned against the second biocompatible layer 55. Alternatively, thestanding fibers 59 can be angled or slanted to favor an organizedcollapse in a second direction opposite the first direction such as, forexample, a distal direction (D) in response to the compressive forces.Alternatively, a compressible adjunct may include a first group of thestanding fibers 59 that are angled or slanted to favor bending in thefirst direction and a second group of the standing fibers 59 that areangled or slanted to favor bending in the second direction. Thedifferent bending directions may cause the compressible adjunct 51 tobend in a disorganized manner.

As illustrated in FIG. 8 , a first loop 66 a originating in the secondbiocompatible layer 55 defines a first pair of standing fibers 59 aextending from the second biocompatible layer 55 toward the firstbiocompatible layer 54. The first loop 66 a holds a second pair ofstanding fibers 59 b defined by a second loop 66 b also originating inthe second biocompatible layer 55. The second loop 66 b is positioned ata distal location with respect to the first loop 66 a. The second pairof standing fibers 59 b also extends toward the first biocompatiblelayer 54. The described pattern is repeated at regular intervals.Likewise, similar loops 66 originating in the first biocompatible layer54 define pairs of standing fibers 59 that extend from the firstbiocompatible layer 54 toward the second biocompatible layer 55.

The spacing between two consecutive pairs of standing fibers 59 can beincreased or decreased to increase or decrease, respectively, thecompressibility of the compressible adjunct 51. Generally, a greaternumber of standing fibers 59 at a certain section of the compressibleadjunct 51 corresponds to a greater stability of that section of thecompressible adjunct 51 under compressive forces.

The loops 66 of the first biocompatible layer 54 are arranged inparallel, or at least substantially parallel, rows 57 a and the loops 66of the second biocompatible layer 55 are arranged in parallel, or atleast substantially parallel, rows 57 b which are spaced apart from therows 57 a.

Referring to FIG. 9 , a staple 10030 is fired into a compressibleadjunct 51 and a tissue (T) comprising a first tissue portion 72 with anaverage tissue thickness (T1) and a second tissue portion 74 with anaverage tissue thickness (T2) greater than the tissue thickness (T1).The fired staple 10030 defines a space therein for accommodating thecaptured compressible adjunct 51 and the captured tissue (T). The spacedefined by the fired staple 10030 is limited, at least in part, by aheight (H3) of the fired staple 10030, as illustrated in FIG. 9 . Thesum of the final thickness of the captured tissue (T) and final heightof the collapsed compressible adjunct 51 is equal, or at leastsubstantially equal, to the height (H3) of the fired staple 10030. Tocompensate for the variability in the thickness of the captured tissue(T), the portion of the compressible adjunct 51 positioned against thesecond tissue portion (T2) is compressed to a final height (H2) greaterthan a final height (H1) of the portion of the compressible adjunct 51positioned against the first tissue portion (T1). The resilience of thestanding fibers 59 permits the compressible adjunct 51 to be compressedto a greater degree against the second tissue portion 74 than the firsttissue portion 72, which permits the compressible adjunct 51 tocompensate for the different thicknesses of the tissue portions 72 and74 within the space defined by the fired staples 10030. The materialcomposition, porosity, frequency, size, and/or orientation of thestanding fibers 59 can be tailored to control or tune thecompressibility of the compressible adjunct 51.

Referring to FIGS. 10-12 , various compressible adjuncts are positionedagainst the cartridge deck 16 of the staple cartridge 12. Thecompressible adjuncts of FIGS. 10-12 are similar in many respects to thecompressible adjuncts 11, 31, and 51. The compressible adjuncts of FIGS.10-12 are further characterized by bonding nodes or interfaces that areinterconnected by one or more standing fibers. For example, asillustrated in FIG. 10 , a compressible adjunct 81 includes a firstseries of bonding nodes 84 a-84 e defined in a first biocompatible layer84 and a second series of bonding nodes 85 a-85 e defined in a secondbiocompatible layer 85 spaced apart from the first biocompatible layer84. Spacer or standing fibers 89 extend from the first series of bondingnodes 84 a-84 e and/or the second series of bonding nodes 85 a-85 e.

The bonding nodes 84 a-84 e are vertically aligned, or at leastsubstantially aligned, with corresponding bonding nodes 85 a-85 e.Moreover, the bonding nodes 84 a-84 e and the bonding nodes 85 a-85 eare arranged, or at least substantially arranged, in corresponding rows102 and 103, respectively. Although only one row of bonding nodes isshown in each of the biocompatible layers 84 and 85, the biocompatiblelayer 84 and/or 85 may each include multiple rows of bonding nodes orinterfaces.

As illustrated in FIG. 10 , the standing fibers 89 may include a firstgroup of standing fibers 89 a and a second group of standing fibers 89 bthat are interlaced to form a mesh like structure. The standing fibers89 a generally follow parallel, or at least substantially parallel,paths that are angled or slanted in a proximal direction (P) withrespect to a vertical axis. On the other hand, the standing fibers 89 bgenerally follow parallel, or at least substantially parallel, pathsthat are angled or slanted in a distal direction (D) with respect to thevertical axis.

An angle α is defined between the fibers 89 a and 89 b extending fromthe a bonding node such as, for example, the bonding node 85 e. Theangle α is any angle in a range of about 10° to about 160°, for example.In certain instances, the angle α is any angle in a range of about 45°to about 135°, for example. In certain instances, the angle α is anyangle in a range of about 60° to about 110°, for example.

As illustrated in FIG. 10 , a standing fiber 89 b extends in theproximal direction (P) from the bonding node 85 a to the bonding node 84d. In other words, the standing fiber 89 b connects a bonding node at afirst position in the row 102 with a bonding node at a fourth positionin the row 103. As a result, the standing fiber 89 b crosses four of thestanding fibers 89 a. In certain instances, the standing fiber 89 b canbe attached to one or more of the four standing fibers 89 a crossed bythe standing fiber 89 b.

Furthermore, a standing fiber 89 a extends in the distal direction (D)from the bonding node 85 e to the bonding node 84 b. In other words, thestanding fiber 89 a connects a bonding node at a fifth position in therow 103 with a bonding node at a second position in the row 102. As aresult, the standing fiber 89 a crosses four of the standing fibers 89b. In certain instances, the standing fiber 89 a can be attached to oneor more of the four standing fibers 89 b crossed by the standing fiber89 a. Crossing the standing fibers 89 a and 89 b improves the stabilityof the compressible adjunct 81 under compressive and/or shear forces.

In certain instances, a standing fiber may extend between a bonding nodeat a first position in a row of bonding nodes on a biocompatible layerand a bonding node at a second position in a row of bonding nodes on adifferent biocompatible layer. In certain instances, a standing fibermay extend between a bonding node at a first position in a row ofbonding nodes on a biocompatible layer and a bonding node at a thirdposition in a row of bonding nodes on a different biocompatible layer.In certain instances, a standing fiber may extend between a bonding nodeat a first position in a row of bonding nodes on a biocompatible layerand a bonding node at a fifth position in a row of bonding nodes on adifferent biocompatible layer. Various bonding nodes at various otherpositions can be connected by the standing fibers 89. In variousinstances, increasing the distances between the interconnected bondingnodes decreases stiffness of a compressible adjunct 81.

Referring to FIG. 12 , the bonding nodes 81 of the biocompatible layer85 are interconnected via bridging members 92 that extend between thebonding nodes of the biocompatible layer 85. As illustrated in FIG. 12 ,a bridging member 92 extends between the bonding nodes 85 a and 85 b.Another bridging member 92 extends between the bonding nodes 85 b and 85c. Additional bridging member 92 may extend between various bondingnodes in the same row or different rows of the biocompatible layer 85.

In certain instances, the bonding nodes of at least one of thebiocompatible layers 84 and 85 are interconnected via the bridgingmembers 92. In certain instances, the bonding nodes of at least one ofthe biocompatible layers 84 and 85 are disconnected from one another. Asillustrated in FIG. 10 , the bonding nodes 84 a-84 e of the firstbiocompatible layer 84 are not directly connected to one another.

Referring to FIG. 12 , a compressible adjunct 81′ is depicted. Thecompressible adjunct 81′ is similar in many respects to the compressibleadjunct 81. In addition, each pair of vertically aligned bonding nodesof the biocompatible layers 84 and 85 is connected by a pair of standingfibers 94. For example, a pair of standing fibers 94 extends between thebonding node 85 a and the bonding node 84 a. The standing fibers 94improve the stability of the compressible adjunct 81′ under compressiveand/or shear forces. In certain instances, only one standing fiber 94extends between the vertically aligned bonding nodes of thebiocompatible layers 84 and 85. In certain instances, three or morestanding fibers 94 extend between the vertically aligned bonding nodesof the biocompatible layers 84 and 85.

Referring to FIG. 11 , a compressible adjunct 100 is depicted. Thecompressible adjunct 100 is similar in many respects to the compressibleadjuncts 81 and 81′. For example, the compressible adjunct 100 includesa first biocompatible layer 84′, which includes bonding nodes 84 a and84 b, and a second biocompatible layer 85′, which includes connectedbonding nodes 85 a and 85 b; however, the first biocompatible layer 84′is offset with the second biocompatible layer 85′ such that the bondingnodes 84 a and 84 b of the first biocompatible layer 84′ are notvertically aligned with the bonding nodes 85 a and 85 b of the secondbiocompatible layer 85′. In an alternative embodiment, however, bondingnodes of the first biocompatible layer 84′ and corresponding bondingnodes of the second biocompatible layer 85′ can be vertically aligned.

As illustrated in FIG. 11 , the offset between the first biocompatiblelayer 84′ and the second biocompatible layer 85′ causes standing fibers94′, which extend between the bonding nodes 84 a and 84 b and thebonding nodes 85 a 85 b, to be angled or slanted to favor bending in apredetermined direction. For example, in the embodiment illustrated inFIG. 11 , the first biocompatible layer 84′ lags behind the secondbiocompatible layer 85′ which causes the bonding node 85 a, for example,to be ahead of the bonding node 84 a. In result, the standing fibers 94′extending between the bonding nodes 85 a and 84 a favor bending in adistal direction (D). The standing fibers 94′ extending between thebonding nodes 84 b and 85 b are also slanted or angled to favor bendingin the distal direction (D). In an alternative embodiment, the standingfibers 94′ can be oriented to favor bending in a proximal direction (P).The pattern is repeated such that the pairs of standing fibers areparallel, or at least substantially, parallel to one another. In atleast one embodiment, one or more of the standing fibers 94′ is orientedto favor bending the proximal direction (P) and one or more of thestanding fibers 94′ is oriented to favor bending in the distal direction(D). The bending direction of the standing fiber 94′ can be chosenbased, in part, on the type, position, and orientation of the treatedtissue (T).

Referring again to FIGS. 10 and 12 , the outer surfaces of thebiocompatible layers 84 and 85 can be tailored to accommodate variousstaple cartridge decks and tissue surfaces. For example, as illustratedin FIGS. 10-12 , the bonding nodes or interfaces of the biocompatiblelayer 84 are not directly connected to one another, which allows thebiocompatible layer 84 additional flexibility to accommodate a steppedcartridge deck, for example. In certain instances, the standing fibersof a compressible adjunct may extend beyond a biocompatible layer tomodify an outer surface of the biocompatible layer.

Referring to FIGS. 13 and 14 , a compressible adjunct 110 is similar inmany respects to the compressible adjuncts 11, 31, 51, 81, 81′, and 100.For example, the compressible adjunct 110 can be positioned against thecartridge deck 16 of the staple cartridge 12. Also, the compressibleadjunct 110 includes a first biocompatible layer 114, a secondbiocompatible layer 115, and spacer or standing fibers 119 that aresimilar in many respects to the compressible layer 84, the compressiblelayer 85, and the standing fibers 89, respectively.

The standing fibers 119 are configured to provide structural support forthe compressible adjunct 110. Adjacent fiber portions 119 a and 119 bare configured to cross one another, as illustrated in FIG. 13 , toincrease the stability of the compressible adjunct 110. ApplyingCompressive forces to the compressible adjunct 110 may cause the fiberportions 119 a and 119 b to bend and/or shift relative to one another.

As illustrated in FIG. 13-16 , the compressible adjuncts 110 and 130include building blocks 111 that are positioned at an outer perimeter ofthe compressible adjunct 110 and/or, in certain instances, at variousother central positions. A building block 111 of the compressibleadjunct 110 includes a pair of fiber portions 119 a that is configuredto cross a pair of fiber portions 119 b at a plane defined at anintermediate distance between the compressible layers 114 and 115. Inaddition, four fiber portions 122 define four corners of the buildingblock 111. Each of the four fiber portions 122 extends, or at leastsubstantially extends, along a vertical axis transecting thebiocompatible layers 114 and 115. In certain instances, the buildingblocks 111 do not include vertical fiber portions. Adjacent buildingblocks 111 share common fiber portions 122.

As illustrated in FIG. 13 , Crossing fiber portions 119 a and 119 bdefine an angle β which can be any angle in a range of about 10° toabout 170°, for example. In certain instances, the angle β can be anyangle in a range of about 30° to about 100°, for example. In certaininstances, the angle β can be any angle in a range of about 50° to about70°, for example.

The standing fibers 119 of the compressible adjunct 110 further definegripping features that protrude from the first biocompatible layer 114.The gripping features can be in the form of traction loops 120. Asillustrated in FIG. 13 , two fiber portions 119 a and 119 b intersect ata bonding node or interface 105 at an inner surface 116 of the firstbiocompatible layer 114, and then extend through the first biocompatiblelayer 114 to form a loop 120 onto an outer surface 118 of the firstbiocompatible layer 114. A fiber 119 can be passed through the firstbiocompatible layer 114 to form several loops 120. Alternatively, theloops 120 can be formed onto the outer surface 118 independently of thefiber 119. For example, another fiber can be employed to form the loops120 onto the first biocompatible layer 114. As illustrated in FIG. 13 ,the loops 120 are aligned with the bonding nodes or interfaces 105.Alternatively, in certain instances, the loops 120 are not be alignedwith the bonding nodes 105.

As illustrated in FIG. 13 , the loops 120 are spaced apart and arrangedin rows 123. The loops 120 can be positioned at an outer perimeter ofthe biocompatible layer 114 and/or, in certain instances, at variousother positions on the first biocompatible layer 114 to provide tractionagainst a cartridge deck 16 of a staple cartridge 12.

The frequency, position, arrangement, and/or size of the loops 120 at aparticular section of the first biocompatible layer 114 can becontrolled to achieve a desired degree of traction against the cartridgedeck 16 at that section of the first biocompatible layer 114. Forexample, if additional traction against the cartridge deck 16 is desiredat a proximal portion of the first biocompatible layer 114, a greaternumber of the traction loops 120 can be formed onto the proximal portionof the outer surface 118 of the first biocompatible layer 114 incomparison to the remainder of the outer surface 118.

In addition, the cartridge deck may also include attachment means forreleasably holding the traction loops 120 to improve the tractionbetween the compressible adjunct 110 and the cartridge deck 16, forexample. Moreover, the first biocompatible layer 114 may be designed toinclude especially dense section(s) for thermoforming or bonding to thecartridge deck 16.

Like the first biocompatible layer 114, the second biocompatible layer115 can also include gripping features for providing traction againsttissue. For example, as illustrated in FIGS. 15 and 16 , a compressibleadjunct 130 includes traction loops 140 that are similar in manyrespects to the traction loops 120. The traction loops 140 arepositioned onto an outer surface 138 of a second biocompatible layer115. Alternatively, the outer surface 138 of the second biocompatiblelayer 115 can be smooth, or at least substantially smooth, and/ortreated to minimize tissue ingrowth and/or adhesion.

In various instances, the gripping features of the biocompatible layers114 and 115, including the loops 120 and 140, can be knitted or wovendirectly onto the biocompatible layers 114 and 115, respectively. In atleast one instance, the first biocompatible layer 114 and/or the secondbiocompatible layer 115 may include satin-type weaves with exposedthreads that are longer in a first direction and shorter in a seconddirection crossing the first direction. The satin-type weaves canincrease traction by resisting flow in the second direction. In variousinstances, the biocompatible layers 114 and 115 can be knitted from oneor more multifilament fibers while the standing fibers 119 comprisemonofilament fibers. The monofilament fibers 119 can be extended beyondthe biocompatible layers 114 and 115 to form the loops 120 and 140. Theextensions of the standing fibers 119 can be looped between the coursesof the knitting pattern of the biocompatible layers 114 and 115, forexample.

In various instances, the gripping features of the biocompatible layers114 and 115, including the loops 120 and 140, can be angled or slantedto improve traction in a predetermined direction. For example, asillustrated in FIGS. 15 and 16 , the loops 140 are slightly angled orslanted in a proximal direction (P) to resist flow of adjacent tissue ina distal direction (D). In an alternative embodiment, the loops 140 canbe slightly angled or slanted in the distal direction (D) to resist flowof adjacent tissue in the proximal direction (P). In certain instances,some of the loops 140 can angled or slanted in the proximal direction(P) and some of the loops 140 can be angled or slanted in the distaldirection (D). In various instances, increasing the height of a loop 140increases its resistance to the flow of adjacent tissue.

Referring to FIGS. 14 and 16 , a knife channel or slot 137 is defined inthe body of each of the compressible adjuncts 110 and 130. When thecompressible adjunct 110 and 114 are positioned against a staplecartridge 12, the knife slot 137 is aligned, or at least substantiallyaligned, with a knife slot 37 that is defined in the staple cartridge12. The knife slots 37 and 137 are configured to accommodate the cuttingedge 9116 as it is advanced to cut tissue captured by the surgicalstapling and severing instrument 8010.

A compressible adjunct such as, for example, the compressible adjuncts110 and/or 130 can be fabricated with a knife slot 137. For example, theknife slot 137 can be woven or knitted as a locally thin area with areduced fiber density in the body of a compressible adjunct.Alternatively, the knife slot 137 can be created in a compressibleadjunct after fabrication. For example, the knife slot 137 can be cutinto a compressible adjunct using a solvent, a heat operation, a diecutting operation, a laser cutting operation, an ultrasonic cuttingoperation, or a combination of these techniques. The knife slot 137helps to minimize the resistance of the compressible adjunct to theadvancement of the cutting edge 9116 which, among other things, canimprove the life of the cutting edge 9116 and/or reduce the forcerequired to advance the cutting edge 9116.

In certain instances, the knife slot 137 may separate a compressibleadjunct into two completely separate portions. Alternatively, asillustrated in FIGS. 17 and 18 , a knife slot 137 extending between twoportions 150 a and 150 b of a compressible adjunct 150 can beinterrupted by one or more bridging members 152 configured to tether thetwo portions 150 a and 150 b. Like the compressible adjuncts 110 and130, each of the portions 150 a and 150 b of the compressible adjunct150 includes a first biocompatible layer 114 positionable against acartridge deck 16, a second biocompatible layer 115 positionable againstthe captured tissue, and spacer or standing fibers 179 which are similarin many respects to the standing fibers 119.

Referring to FIGS. 17-19 , the standing fibers 179 are configured toprovide structural support for the compressible adjunct 150. Adjacentfiber portions 179 a and 179 b are configured to cross one another, asillustrated in FIGS. 17-19 , to increase the stability of thecompressible adjunct 150 under compressive and/or shear forces. Applyingcompressive forces to the compressible adjunct 150 may cause the fiberportions 179 a and 179 b to bend and or shift relative to one another.Like the compressible adjunct 51 (FIG. 9 ), the compressible adjunct 150can accommodate tissue with portions of different thicknesses.

Referring to FIG. 19 , the biocompatible layers 114 and 115 of thecompressible adjunct 150 extend in parallel, or at least substantiallyparallel, with each other. Fiber portions 179 a, 179 b, and 172 extendbetween the biocompatible layers 114 and 115 to maintain a separationbetween the biocompatible layers 114 and 115. The fiber portions 179 aare parallel, or at least substantially parallel, to one another. Afiber 179 a extends, or at least substantially extends, along an axis171 that intersects the biocompatible layers 114 and 115 at an angle α1.Likewise, the fiber portions 179 b are parallel, or at leastsubstantially parallel, to one another. A fiber 179 b extends, or atleast substantially extends, along an axis 173 that intersects thebiocompatible layers 114 and 115 at an angle α2. In certain instances,the angles α1 and α2 are the same, or at least substantially the same.

The angle α1 can be any angle in a range of about 10° to about 170°, forexample. In certain instances, the angle α1 can be any angle in a rangeof about 30° to about 100°, for example. In certain instances, the angleα1 can be any angle in a range of about 50° to about 70°, for example.Other values for the angle α1 are contemplated by the presentdisclosure.

The angle α2 can be any angle in a range of about 10° to about 170°, forexample. In certain instances, the angle α2 can be any angle in a rangeof about 30° to about 100°, for example. In certain instances, the angleα2 can be any angle in a range of about 50° to about 70°, for example.Other values for the angle α2 are contemplated by the presentdisclosure.

As illustrated in FIG. 19 , the fiber portions 179 a and 179 b may crossone another defining a plurality of “X-shaped” structures. Bonding nodesor interfaces 175 and 178 are defined in the biocompatible layers 115and 114, respectively, between the neighboring X-shaped structures. Endsof the fiber portions 179 a and 179 b intersect at the bonding nodes 175and 178. An angle β is defined between crossing fiber portions 179 a and179 b. The angle β can be any angle in a range of about 10° to about180°, for example. In certain instances, the angle can be any angle in arange of about 30° to about 100°, for example. In certain instances, theangle β can be any angle in a range of about 50° to about 70°, forexample. In at least one instance, the angle β is equal, or at leastsubstantially equal, to the angle α1 and/or the angle α2, for example.

Furthermore, fiber portions 172, including fiber portions 172 a-172 e,extend between the biocompatible layers 114 and 115. The fiber portions172 are perpendicular, or at least substantially perpendicular, to thebiocompatible layers 114 and 115. As illustrated in FIG. 19 , a fiberportion 172 a extends, or at least substantially extends, along an axis177 that intersects the biocompatible layers 114 and 115 at an angle α3.The angle α3 can be any angle in a range of about 80° to about 100°, forexample. In certain instances, the angle α3 can be any angle in a rangeof about 85° to about 95°, for example. In certain instances, the angleα3 can be any angle in a range of about 87° to about 93°, for example.Other values for the angle α3 are contemplated by the presentdisclosure.

Moreover, the fiber portions 172 are spaced apart from one another. Thefiber portions 172 can be equidistant from one another or arranged inany other suitable configuration. As illustrated in FIG. 19 , a fiberportion 172 c passes through an intersection point 174 of an X-shapedstructure defined by crossing fiber portions 179 a and 179 b. A fiberportion 172 d partially passes through an intersection point 174 of anX-shaped structure defined by crossing fiber portions 179 a and 179 b.In certain instances, two or more fiber portions 172 can pass, orpartially pass, through intersection points of X-shaped structuresdefined by crossing fiber portions 179 a and 179 b. In certaininstances, bonding nodes or interfaces can be created at one or more ofthe intersection points 174 by using a biocompatible bonding medium suchas, for example, biocompatible glue.

Referring to FIG. 19 , a fiber portion 172 b is positioned on a side ofan X-shaped structure of crossing fiber portions 179 a and 179 b suchthat the fiber portion 172 b intersects the crossing fiber portions 179a and 179 b of such X-shaped structure. In certain instances, two ormore fiber portions 172 can positioned like the fiber portion 172 b withrespect to two or more X-shaped structures.

As illustrated in FIG. 19 , the bonding nodes 175 are verticallyaligned, or at least substantially aligned, with the bonding nodes 178.In certain instances, fiber portions 172 may extend between the bondingnodes 175 and 178 that are vertically aligned such as, for example, thefiber portion 172 e.

Referring to FIGS. 17 and 18 , the bridging members 152 are severed bythe cutting edge 9116 during advancement of the cutting edge 9116 to cutthe tissue captured by the surgical stapling and severing instrument8010. Alternatively, one or more of the bridging members 152 may bepositioned outside the path of the cutting edge 9116, and may continueto tether the portions 150 a and 150 b after the surgical stapling andsevering instrument 8010 is fired.

Referring to FIGS. 20-22 , portions 150 a and 150 b of a compressibleadjunct 160 are tethered via bridging members 162. As illustrated inFIG. 20 , the bridging members 162 are spaced apart to provide discreteattachment means between the portions 150 a and 150 b along a length ofthe knife slot 137. One or more of the bridging members 162 can besevered by the cutting edge 9116 as it is advanced to cut tissuecaptured by the surgical stapling and severing instrument 8010.

As illustrated in FIGS. 21 and 22 , the bridging members 162 are alsoconfigured to attach or tether the compressible adjunct 160 to a staplecartridge 12. Segments of the bridging members 162 are extended throughcutouts or holes 164 in a bottom portion 17 of the staple cartridge 12to secure the compressible adjunct 160 to the staple cartridge 12. Thebridging members 162 can also passed through the knife slots 37 and 137.The bridging members 162 can be severed to release the portions 150 aand 150 b from each other and/or the staple cartridge 12 by shearing orcutting actions caused by the passing of the cutting edge 9116 as thecutting edge 9116 is advanced to cut tissue captured by the surgicalstapling and severing instrument 8010.

As illustrated in FIGS. 21 and 22 , the cutouts 164 are formed atdiscrete positions on opposite sides of the knife slot 37 of the staplecartridge 12. In certain instances, the bridging members 162 are in theform of sutures, for example, that are threaded through the cutouts 164to attach the compressible adjunct 160 to the staple cartridge 12. Incertain instances, the cutouts 164 can be replaced or used incombination with projections that extend from the bottom portion 17 ofthe staple cartridge 12. The projections can be configured to hold thesegments of the bridging members 162 that attach the compressibleadjunct 160 to the staple cartridge 12. Other attachment means can beformed in the staple cartridge 12 to facilitate attachment of thecompressible adjunct 160 to the staple cartridge 12 by the bridgingmember 162.

Referring to FIG. 23 , a bridging sheath 182 may extend between twoportions of a compressible adjunct 180. In FIG. 23 , the bridging sheath182 has been severed by the cutting edge 9116. Only one portion 150 a ofthe compressible adjunct 180 is shown. Also, a portion of the severedbridging sheath 182 that remained attached to the portion 150 a of thecompressible adjunct 180 is shown. The cutting edge 9116 is advancedthrough the knife slots 37 and 137 along a path defined by alongitudinal axis AA to sever the bridging sheath 182.

In certain instances, as illustrated in FIG. 23 , the bridging sheath182 is defined between the portions of the compressible adjunct 180 atthe bottom of the knife slot 137. In such instances, the bridging sheath182 can be a part of the first biocompatible layer 114 that extendsbetween the two portions of the compressible adjunct 180. Also, in suchinstances, when the compressible adjunct 180 is positioned against thecartridge deck 16 of the staple cartridge 12, the bridging sheath 182separates, or at least partially separates, the knife slot 137 of thecompressible adjunct 180 and the knife slot 37 of the staple cartridge12.

In other instances, the bridging sheath 182 is defined between theportions of the compressible adjunct 180 at the top of the knife slot137 of the compressible adjunct 180. In such instances, the bridgingsheath 182 can be a part of the second biocompatible layer 115 thatextends between the two portions of the compressible adjunct 180. Also,in such instances, when the compressible adjunct 180 is positionedagainst the cartridge deck 16 of the staple cartridge 12, the bridgingsheath 182 does not separate the knife slot 137 of the compressibleadjunct 180 from the knife slot 37 of the staple cartridge 12. Instead,the knife slots 137 and 37 are positioned below the bridging sheath 182.In yet other instances, the bridging sheath 182 may extend between theportions of the compressible adjunct 180 through, or at leastsubstantially through, a plane defined between the biocompatible layers114 and 115 of the compressible adjunct 180, for example.

Referring again to FIG. 23 , the compressible adjunct 180 can beattached to the staple cartridge 16 by tethering the bridging sheath 182to the bottom portion 17 of the staple cartridge 16. For example,attachment means such as sutures can be threaded through the bridgingsheath 182 and the cutouts 164 to tether the bridging sheath 182 to thebottom portion of the staple cartridge 12. The sutures can be severed bythe cutting edge 9116, for example, to progressively release thecompressible adjunct 180 from the staple cartridge 12. Attaching thecompressible adjunct 180 to the staple cartridge 16 by passing thesutures only through bridging sheath 182 at the bottom of the knife slot137 frees the remainder of the compressible adjunct 180 to be compressedwithout losing attachment tension in the sutures. The same can beachieved by passing the sutures only through the first biocompatiblelayer 114, for example.

Referring to FIGS. 24 and 25 , a compressible adjunct 190 is positionedagainst a cartridge deck 16 of a staple cartridge 12. The compressibleadjunct 190 is similar in many respects to the compressible adjuncts 11,31, 51, 81, 81′, 100, 110, 130, 150, and/or 180. For example, thecompressible adjunct 190 includes a first biocompatible layer 114, asecond biocompatible layer 115, and spacer or standing fibers 199extending between the biocompatible layers 114 and 115.

As illustrated in FIG. 24 , the compressible adjunct 190 is secured tothe staple cartridge 12 by securing members 191 that include bendablebarbs or projections 192 protruding from an elongate support member 194.The bendable projections 192 are shaped like arrow heads that areconfigured to pierce into a structure with relative ease but resistremoval from the structure until sufficient force is applied to bend thebendable projections 192 away from the elongate support member 194.

The bendable projections 192 are arranged on opposite end portions 195and 196 of the elongate support member 194. In at least one example, asillustrated in FIG. 24 , three bendable projections 192 are positionedon each of the opposite end portions 195 and 196. The bendableprojections 192 of each of the opposite end portions 195 and 196 arespaced apart with equal distances therebetween. More or less than threebendable projections 192 can be placed on each of the opposite endportions 195 and 196. Other arrangements of the bendable projections 192with respect to the elongate support member 194 are contemplated by thepresent disclosure.

Referring to FIG. 24 , two securing members 191 are employed to secureat least a portion of the compressible cartridge 190 to the staplecartridge 12. More or less than two securing members 191 can be employedto secure the compressible cartridge 190 to the staple cartridge 12. Asillustrated in FIG. 24 , end portions 195 of the securing members 191are inserted through the biocompatible layer 114 while end portions 196are inserted through the cartridge deck 16 into a staple cavity 197 ofthe staple cartridge 12. A staple 10030 is positioned in the staplecavity 197. The deployment of the staple 10030 from the staple cavity197 is blocked, or at least partially blocked, by the end portions 196.As the staple 10030 is deployed from the staple cavity 197, the staple10030 pushes the end portions 196 out of the staple cavity 197 freeingthe securing members 191 from the staple cartridge 12.

End portions 196 of other securing members 191 can be progressivelyfreed from other staple cavities 197 of the staple cartridge 12 duringdeployment of their respective staples 10030. Since the staples 10030are progressively released from their respective staple cavities 197 byadvancement of the wedge sled 9126 (FIG. 4 ), a correspondingprogressive release of the compressible adjunct 190 is also achieved bythe advancement of the wedge sled 9126 during the firing sequence of thesurgical stapling and severing instrument 8010. Essentially, a securingmember 191 with an end portion 196 that is inserted into a more proximalstaple cavity is released before a securing member 191 with an endportion 196 that is inserted into a more distal staple cavity.

The progressive release of the compressible adjunct 190 maintains therelative positioning between the compressible adjunct 190 and staplecartridge 12 at discrete locations on the cartridge deck 16 until thestaples 10030 at such locations are fired from their respective staplecavities 197. The securing members 191 also resist bunching of thecompressible adjunct 190 that may occur as the cutting edge 9116 isadvanced during the firing sequence of the surgical stapling andsevering instrument 8010.

Referring to FIG. 24 , the securing members 191 at a staple cavity 197extend in parallel, or at least substantially in parallel, to oneanother. In at least one instance, the securing members 191 at a staplecavity 197 may cross one another defining an “X” shape, for example.

Referring to FIG. 24 , the most exterior bendable projections 192 oneach of the opposite end portions 195 and 196 of the elongate supportmember 194 can define piercing tips for penetrating through a structure.The piercing tips can be especially hardened to facilitate penetrationinto a structure. Furthermore, the arrow head shape of the bendableprojections 192 may improve the stability of the attachment between thesecuring members 191 and the compressible adjunct 190 by entanglement ofthe bendable projections 192 with the standing fibers 199, for example.

Referring to FIG. 25 , an end portion 196 of an elongate support member194 of a securing member 191 is inserted into a staple cavity 197 of thestaple cartridge 12. The end portion 196 includes four bendableprojections 192 that define attachment portions 192 a protruding fromthe elongate support member 194 on a first side of the elongate supportmember 194 and attachment portions 192 b protruding from the elongatesupport member 194 on a second side of the elongate support member 194opposite the first side. The attachment portions 192 a define an angleα1 with the elongate support member 194 on the first side while theattachment portions 192 b define an angle α2 with the elongate supportmember 194 on the second side.

In certain instances, the angle α1 and/or the angle α2 can be any anglein a range of about 1° to about 90°, for example. In certain instances,the angle α1 and or the angle α2 can be any angle in a range of about30° to about 70°, for example. In certain instances, the angle α1 and orthe angle α2 can be any angle in a range of about 40° to about 60°, forexample. In at least one instance, the angle α1 is equal, or at leastsubstantially equal, to the angle α2. In at least one instance, theangle α1 is different from the angle α2.

As illustrated in FIG. 25 , the bendable projections 192 each includeattachment portions 192 a and 192 b extending from a same position onthe elongate support member 194. Alternatively, a bendable projection192 may include only one of the attachment portions 192 a and 192 b. Inat least one instance, the attachment portions 192 a and 192 b of thebendable projections 192 are made from biocompatible fibers that extendfrom the elongate support member 194. In at least one instance, theelongate support member 194 can also be made from biocompatible fibers.

In various instances, the edges of a compressible adjunct can beconfigured to improve attachment with a cartridge deck 16 of a staplecartridge 12 and/or improve the structural performance of thecompressible adjunct. As illustrated in FIG. 17 , edges 151 a and 151 bof the portions 150 a and 150 b, respectively, of the compressibleadjunct 150 are each formed down to an outer lip 153 which defines anouter perimeter of the compressible adjunct 150, and can be attached tothe cartridge deck 16, for example.

In certain instances, an outer lip can be formed after fabrication of acompressible adjunct. For example, the outer perimeters of thebiocompatible layers of a compressible adjunct can be subjected to heatand/or pressure to form the outer lips. In certain instances, outer lipscan be formed by weaving or knitting, for example, outer perimeters ofthe biocompatible layers of a compressible adjunct into a unitedstructure that defines the outer lips. As illustrated in FIG. 26 , anouter lip 203 of a compressible adjunct 200 is formed by knitting outerperimeters 217 and 218 of the biocompatible layers 114 and 115,respectively, of a compressible adjunct 200 into a united structure thatdefines the outer lip 203.

Uniting the outer perimeters of the biocompatible layers of acompressible adjunct can help stabilize the compressible adjunct and/orminimize shear collapse during compression. In certain instances,however, it is desirable to maintain the spacing between the outerperimeters of the biocompatible layers of a compressible adjunct tominimize structural and/or other differences between the outerperimeters and the center of a compressible adjunct that may result fromthe modification.

Referring to FIG. 27 , a tapered edge 212 is defined in a compressibleadjunct 210. The compressible adjunct 210 includes a first biocompatiblelayer 214 which extends laterally beyond a second biocompatible layer215. Alternatively, a compressible adjunct 210 can include a secondbiocompatible layer 215 that extends laterally beyond the firstbiocompatible layer 214.

The biocompatible layers 214 and 215 are similar in many respects to thebiocompatible layers 114 and 115. For example, the first biocompatiblelayer 214 is configured to be positioned against and/or attached to thecartridge deck 16 and the second biocompatible layer 215 is configuredto be positioned against tissue captured between the anvil 8014 and thestaple cartridge 12. In at least one instance, a tapered edge 212 of thecompressible adjunct 210 is formed by removing or cutting off a portionof the compressible adjunct 210. The cutting plane can be made at apredetermined angle depending on the desired sharpness of the taperededge 212.

Referring to FIGS. 28-30 , a compressible adjunct 230 is depicted. Thecompressible adjunct 230 is similar to other compressible adjunctsdescribed in the present disclosure. For example, like the compressibleadjunct 51 (FIG. 9 ), the compressible adjunct 230 can compensate forthe variability in the thickness of tissue (T) captured with thecompressible adjunct 230 by the staples 10030. As illustrated in FIG. 28, the compressible adjunct 230 is configured to accommodate a tissue (T)with tissue portions 72 and 74 having different tissue thicknesses whenthe tissue portions 72 and 74 are captured with compressible adjunct 230by the staples 10030.

Referring to FIG. 28 , the compressible adjunct 230 includes a pluralityof structural cells 236 positioned between a cartridge contactingsurface 234 and a tissue contacting surface 235. One or more of thestructural cells 236 can extend longitudinally along, or at leastsubstantially along, an entire length of the compressible adjunct 230. Astructural cell 236 is generally surrounded by walls that define anouter perimeter on the structural cell 236. Neighboring structural cells236 may share one or more walls.

Referring to FIG. 29 , a structural cell 236 is defined by six walls andcomprises a hexagonal shape. In at least one instance, one or more ofthe structural cells 236 may each include three or more walls. Thestructural cells 236 of a compressible adjunct 230 may include the samenumber of walls. Alternatively, a first group of structural cells 236may include a first number of walls while a second group of structuralcells 236 may include a second number of walls different from the firstnumber of walls, for example. In at least one instance, the structuralcells 236 define a honeycomb shape that extends longitudinally along, orat least substantially along, at least a portion of the entire length ofthe compressible adjunct 230.

The honeycomb shape improves the stability of the compressible adjunct230 under compressive and/or shear forces. In addition, thehoneycomb-shaped structural cells 236 are bendable under compressionapplied to the compressible adjunct 230 and tissue (T) positionedagainst the second biocompatible layer 215 as an anvil 8014 is movedinto a closed position opposite the staple cartridge 12. As illustratedin FIGS. 29 and 30 , the honeycomb-shaped structural cells 236 areconfigured to experience a reduction in height when compressive forcesare applied to the compressible adjunct 230 which permits thecompressible adjunct 230 to accommodate tissue (T) with tissue portions72 and 74 having different tissue thicknesses when the tissue portions72 and 74 are captured with the compressible adjunct 230 by the staples10030, as illustrated in FIG. 28 .

Referring to FIGS. 29 and 30 , a structural cell 236 has experienced areduction in height from a first height (H1), as illustrated in FIG. 29, to a second height (H2), as illustrated in FIG. 30 in response to thecompression forces applied to the compressible adjunct 230 as the anvil8014 is moved into the closed position opposite the staple cartridge 12.The reduction in height may correspond to the thickness of the capturedtissue (T) positioned against the compressible adjunct 230 where thestructural cell 236 is located. In other words, the greater thethickness of a tissue portion, the greater the reduction in height of astructural cell 236 located at a portion of the compressible adjunct 230positioned against that tissue portion.

The ratio of the second height (H2) to the first height (H1) can be anyvalue from about 0.05 to about 0.95, for example. In certain instances,the ratio of the second height (H2) to the first height (H1) can be anyvalue from about 0.2 to about 0.7, for example. In certain instances,the ratio of the second height (H2) to the first height (H1) can be anyvalue from about 0.3 to about 0.6, for example. Other values for theratio of the second height (H2) to the first height (H1) arecontemplated by the present disclosure.

The walls of a structural cell 236 may comprise the same, or at leastsubstantially the same, thickness. Alternatively, as illustrated in FIG.29 , the walls of a structural cell 236 may comprise differentthicknesses. A pair of opposite walls 242 may comprise a first thickness(T1), a pair of opposite walls 244 may comprise a second thickness (T2),and a pair of opposite walls 246 may comprise a third thickness (T3),wherein at least two of the first thickness (T1), the second thickness(T2), and/or the third thickness (T3) are different from one another.For example, as illustrated in FIG. 29 , the first thickness (T1) of thewalls 242 is greater than the second thickness (T2) of the walls 244,and greater than the third thickness (T3) of the walls 246

Referring to FIGS. 28-30 , the walls 242 of a structural cell 236 extendin parallel, or at least substantially in parallel, with the firstbiocompatible layer 234 and the second biocompatible layer 235. Incertain instances, a wall 242 of a structural cell 236 may define aportion of the first biocompatible layer 234. In certain instances, awall 242 of a structural cell 236 may define a portion of the secondbiocompatible layer 235.

As illustrated in FIG. 28 , a building block of a compressible adjunct230 includes five structural cells 236 that include a central structuralcell 236 which shares walls with the other four structural cells 236. Aheight (H) of a compressible adjunct 230 can be defined by a stack oftwo structural cells 236 sharing a wall 244, as illustrated in FIG. 29 .Alternatively, a height (H) of a compressible adjunct 230 can be definedby a stack of two four-walled structural cells 237 and one structuralcell 236 extending between the structural cells 237, as illustrated inFIG. 29 . The structural cell 236 shares a wall 242 with each of thestructural cells 237. Other geometries and arrangements of thestructural walls of a compressible adjunct 230 are contemplated by thepresent disclosure.

Various attachments can be fixed or secured to a compressible adjunct ofthe present disclosure. An attachment can be made from the same, or atleast substantially the same, material(s) as the compressible adjunct.Alternatively, an attachment can be made from different material(s) thanthe compressible adjunct. In at least one instance, an attachment can bemade from the same material(s) as the compressible adjunct but thematerial(s) are treated differently to modify one or more of thechemical and/or physical properties, for example, of the attachment.

In at least one instance, a compressible adjunct can be harder or softerthan an attachment that is secured to the compressible adjunct. A harderattachment can provide a desirable stiffness for securing the attachmentto a cartridge deck, for example. Alternatively, a softer attachment canyield a more delicate interaction with sensitive tissue, for example. Inat least one instance, a compressible adjunct may comprise smoother orrougher surfaces than the surfaces of an attachment that is secured tothe compressible adjunct. Ultimately, an attachment can be tailored toperform various functions in connection with a compressible adjunct. Invarious instances, an attachment may be in the form of a side attachmentor an end cap for a compressible adjunct.

Referring to FIGS. 28-30 , a side attachment 250 is fixed or secured tothe compressible adjunct 230. In at least one instance, a sideattachment 250 can be secured to the compressible adjunct 230 by weldingusing heat or a solvent, for example. The side attachment 250 defines atapered edge 252 of the compressible adjunct 230.

Furthermore, the side attachment 250 can be employed to attach thecompressible adjunct 230 to a cartridge deck 16 of a staple cartridge12, for example. In at least one instance, the side attachment 250 canbe welded onto the cartridge deck 16 by using heat or a solvent, forexample. Other techniques for securing a side attachment 250 to acompressible adjunct 230 and/or to a cartridge deck 16 are contemplatedby the present disclosure. For example, a tether 254 (FIG. 29 ) of aside attachment 250 can be secured to and/or wrapped around a staplecartridge 12.

A compressible adjunct and/or a side attachment can be configured tofacilitate tissue ingrowth. For example, as illustrated in FIGS. 28-30 ,the compressible adjunct 230 and the side attachment 250 includeperforations 254 configured to facilitate tissue ingrowth into thecompressible adjunct 230 and the side attachment 250. The perforations254 can be selectively created through the compressible adjunct 230and/or the side attachment 250 in areas where tissue ingrowth isdesirable.

In various instances, a compressible adjunct 230 and/or a sideattachment 250 can be fabricated by various extrusion techniques, forexample, and the perforations 254 can be laser drilled, for example,into desired portions of the compressible adjunct 230 and/or the sideattachment 250. A side attachment 250 can be attached to a compressibleadjunct 230 after extrusion, for example. A tailored compressionresistance can be achieved in a compressible adjunct 230 by fabricatingthe walls of structural cells such as, for example, the structural cells236 to predetermined thicknesses. Patterns of non-uniform wallthicknesses can be extruded, for example, to tune the flexibility of thestructural cells within a compressible adjunct 230 to achieve a desiredstiffness regardless of the material(s) used in the fabrication of thecompressible adjunct 230.

Referring to FIG. 31 , a compressible adjunct 260 is depicted. Thecompressible adjunct 260 includes a first biocompatible layer 114positioned against a cartridge deck 16 of a staple cartridge 12. Inaddition, the compressible adjunct 260 includes a second biocompatiblelayer 115 positionable against tissue (T). A plurality of standing orspacer walls 262 are defined between the biocompatible layers 114 and115. The standing walls 262 are configured to maintain a space betweenthe biocompatible layers 114 and 115, as illustrated in FIG. 31 . Inaddition, the standing walls 262 are bendable under compression appliedto the compressible adjunct 260 and tissue (T) positioned against thesecond biocompatible layer 115 as an anvil 8014 is moved into a closedposition opposite the staple cartridge 12.

The standing walls 262 are attached to the biocompatible layers 114 and115, and are spaced apart from one another. Alternatively, the standingwalls 262 can be tethered or attached to one another. Some of thestanding walls 262 are arranged in parallel, or at least substantiallyin parallel, to one another. Other standing walls 262, however, extendin intersecting planes.

Furthermore, the standing walls 262 comprise cutouts or gaps 264 thatimprove the flexibility of the standing walls 262. In at least oneinstance, one or more of the standing walls 262 can be fabricated withthe cutouts 264 by extrusion, for example. Alternatively, the cutouts264 can be created after fabrication of the standing walls 262 iscompleted. The cutouts 264 can be strategically positioned to achieve adesired flexibility of the compressible adjunct 260, for example.

Referring to FIG. 32 , a compressible adjunct 270 includes a firstbiocompatible layer 114 positioned against a cartridge deck 16 of astaple cartridge 12. The compressible adjunct 270 lacks a secondbiocompatible layer. Accordingly, tissue (T) is directly positionedagainst a plurality of spacer or standing walls 272 of the compressibleadjunct 270. Alternatively, the compressible adjunct 270 can include asecond biocompatible layer on an opposite side of the standing wall 272.In such instances, tissue (T) can be positioned against the secondbiocompatible layer. In addition, the standing walls 272 are bendableunder compression applied to the compressible adjunct 270 and tissue (T)positioned against the standing walls 272 as an anvil 8014 is moved intoa closed position opposite the staple cartridge 12.

The standing walls 272 include longitudinal walls 272 a and transversewalls 272 b intersecting the longitudinal walls 272 a. The standingwalls 272 comprise hollow, or at least substantially hollow, frames, asillustrated in FIG. 32 . Alternatively, the standing walls 272 maycomprise solid frames. In various instances, the standing walls 272comprise the shape of a triangular prism, for example. The standingwalls 272 comprise triangular cross-sectional areas. The standing walls272 may comprise square-shaped, rectangular, and/or curvedcross-sectional areas in addition to or instead of the triangularcross-sectional areas. As illustrated in FIG. 32 , the longitudinalwalls 272 a comprise transverse cross-sectional areas that are triangleshaped and the transverse walls 272 b comprise longitudinalcross-sectional areas that are triangle shaped.

A longitudinal wall 272 a comprises a base 276 a defined by the firstbiocompatible layer 114 and an apex 274 a extending longitudinally inparallel, or at least substantially in parallel, with other apexes 274 aof neighboring longitudinal walls 272 a. A transverse wall 272 b alsocomprises a base 276 b defined by the first biocompatible layer 114 andan apex 274 b extending transversely in parallel, or at leastsubstantially in parallel, with other apexes 274 b of neighboringtransverse walls 272 b.

As illustrated in FIG. 32 , the compressible adjunct 272 includesstructural cells 278 that comprise inverted pyramid shapes. A structuralcell 278 is defined between two parallel, or at least substantiallyparallel, walls 272 a and two parallel, or at least substantiallyparallel, walls 272 b intersecting the walls 272 a. A base 280 of astructural cell 278 comprises four corners 282 defined by theintersecting walls 272 a and 272 b. An apex 284 of a structural cell 278is defined at the first biocompatible layer 114. Each structural cell278 extends from an apex 284 and terminates at a base 280, asillustrated in FIG. 32 .

In various instances, the second biocompatible layer of a compressibleadjunct of the present disclosure such as, for example, the secondbiocompatible layer 115 of the compressible adjunct 110 is visible whenthe compressible adjunct 110 is positioned against a cartridge deck 16of a staple cartridge 12. In various instances, certain information canbe communicated to an operator through images, words, symbols, and/orcolors that are knitted or printed onto the second biocompatible layer.For example, knitting lines can be employed to show knife travel length,which may help an operator to reduce the number of loads used in aprocedure. Knitting lines can also be employed to show the positions ofstaple crowns. Moreover, knitting lines can also be employed to provideinformation about a staple cartridge employed with the compressibleadjunct such as, for example staple heights. Furthermore, knitting linescan also be employed to outline an optimal location for positioning thetreated tissue against the compressible adjunct.

A staple cartridge assembly comprising an implantable layer 4000 isdepicted in FIG. 33 . The staple cartridge assembly further comprises acartridge body 12 including a deck 16 which supports the layer 4000. Thelayer 4000 comprises a bottom portion 4004 supported by the deck 16 and,in addition, a top portion 4005. The bottom portion 4004 and the topportion 4005 are connected by walls 4009. The walls 4009 extendlaterally across the layer 4000; however, the walls 4009 can extend inany suitable direction, such as longitudinally, for example. In at leastone embodiment, the cartridge body 12 comprises a longitudinal slotconfigured to receive a cutting member and the walls 4009 extend acrossthe longitudinal slot.

The walls 4009 define chambers 4008 therebetween. When a load is appliedto the layer 4000, the chambers 4008 permit the walls 4009 to flex,deflect, and/or collapse. The amount in which the walls 4009 deflect isdependent on the thickness of the tissue clamped against the layer 4000.When tissue is pressed downwardly onto the layer 4000, the layer 4000can adapt to the thickness of the tissue pressed against the layer 4000.Stated another way, the layer 4000 can provide local adaptations tolocal variations in tissue thickness, as illustrated in FIG. 34 . Invarious instances, the walls 4009 define seams in the layer 4000. Theseams can be lateral seams and/or longitudinal seams, for example. Thearrangement of the seams can control the deflection of the layer 4000.

Further to the above, the layer 4000 comprises structural fibers 4006and reinforcement fibers 4007. The structural fibers 4006 are arrangedto form the bottom portion 4004, the top portion 4005, and the walls4009. In at least one instance, as illustrated in FIG. 33 , thestructural fibers 4006 are arranged in longitudinal rows which formlongitudinal seams therebetween. The structural fibers 4006 form columnsor pillars which extend between and connect the bottom portion 4004 andthe top portion 4005. The reinforcement fibers 4007 are interwovenwithin the bottom portion 4004, the top portion 4005, and/or the walls4009. In at least one instance, the reinforcement fibers 4007 areknotted, looped, and/or wrapped around the structural fibers 4006. Invarious instances, the reinforcement fibers 4007 are interlocked withthe structural fibers 4006.

The reinforcement fibers 4007 connect the structural fibers 4006 withinthe walls 4009. The reinforcement fibers 4007 hold or tie the pillarswithin the walls 4009 together to provide the walls 4009 with desirablestructural properties. For instance, walls 4009 having a higher densityof the reinforcement fibers 4007 are stronger than walls 4009 having alower density. Similarly, the density of the reinforcement fibers 4007within the bottom portion 4004 and/or the top portion 4006 can affectthe strength of the portions 4004 and/or 4006.

As a result of the above, the structural pillars within a wall 4009 canflex and move together. Moreover, the structural fiber pillars 4006within a wall 4009 are supported by the adjacent structural fiberpillars 2006 owing to the reinforcement fibers 4007. As illustrated inFIG. 33 , the reinforcement fibers 4007 within one wall 4009 are notdirectly connected to the reinforcement fibers 4007 in an adjacent wall4009; however, the reinforcement fibers 4007 in a first wall 4009 can beconnected to the reinforcement fibers 4007 in a second wall 4009 via thebottom portion 4004 and/or the top portion 4006. In various alternativeembodiments, reinforcement fibers 4007 can directly span between andconnect the adjacent walls 4009.

The structural fibers 4006 and the reinforcement fibers 4007 can beattached to each other at knot interfaces. The knot interfaces cancomprise any suitable knot type. The type of knot interfaces that areused can affect the stiffness of the layer 4000. For instance, if looseknots are used, the layer 4000 can be less stiff or have a lower modulusof elasticity. Alternatively, if tight knots are used, the layer 4000can be stiffer or have a higher modulus of elasticity. The layer 4000can utilize any suitable type, or types, of knots.

Further to the above, the knots between the structural fibers 4006 andthe reinforcement fibers 4007 can be utilized to selectively providedifferent portions of the layer 4000 with different stiffnesses ormoduli of elasticity. For instance, the types of knots and/or thefrequency of the knots between the structural fibers 4006 and thereinforcement fibers 4007 can be selected to create a first compressionzone and a second compression zone. The first compression zone has afirst stiffness and the second compression zone has a second stiffnesswhich is greater than the first stiffness. In at least one instance, thefirst compression zone is aligned with and positioned over alongitudinal slot defined in the deck 12 which is configured to receivea cutting member and the second compression zone is aligned with andpositioned over staple cavities defined in the deck 12. Such anarrangement can facilitate the transection of the layer 4000 whileproviding desirable tissue thickness compensation properties within thestaples 10030 that capture the layer 4000 against the tissue. In certaininstances, the first compression zone is aligned with a proximal end ofthe deck 12 and the second compression zone is positioned distally withrespect to the first compression zone. In at least one such instance,another first compression zone is positioned distally with respect tothe second compression zone. Such an arrangement can facilitate thetransection of the layer 4000 at the beginning and at the end of thecutting stroke of the cutting member.

The structural fibers 4006 comprise a first cross-sectional width, ordiameter, and the reinforcement fibers 4007 comprise a secondcross-sectional width, or diameter, that is different than the firstcross-sectional width. As illustrated in FIGS. 33 and 34 , thecross-sectional width of the structural fibers 4006 is wider than thecross-sectional width of the reinforcement fibers 4007. In at least oneinstance, the cross-sectional width of the structural fibers 4006 istwice as wide as the cross-sectional width of the reinforcement fibers4007, for example.

The structural fibers 4006 are comprised of a first material and thereinforcement fibers 4007 are comprised of a second material which isdifferent than the first material. In at least one embodiment, thestructural fibers 4006 are comprised of a first polymeric material andthe reinforcement fibers 4007 are comprised of a second polymericmaterial which has a lower modulus of elasticity than the modulus ofelasticity of the first polymeric material. In an alternativeembodiment, the structural fibers 4006 are comprised of a firstpolymeric material and the reinforcement fibers 4007 are comprised of asecond polymeric material which has a higher modulus of elasticity thanthe modulus of elasticity of the first polymeric material. In certainembodiments, the structural fibers 4006 are comprised of more than onepolymeric material and/or the reinforcement fibers 4007 are comprised ofmore than one polymeric material. In at least one such embodiment, thestructural fibers 4006 and the reinforcement fibers 4007 have at leastone material in common with one another and at least one material not incommon.

Turning now to FIG. 35 , an implantable layer 4100 comprises a topportion 4105 and pillar walls 4109 which support the top portion 4105.The top portion 4105 comprises longitudinal structures or fibers 4103which are interconnected by structural fibers 4106 which comprise thepillar walls 4109. The structural fibers 4106 are looped, wrapped,and/or knotted around the longitudinal fibers 4103 in any suitablemanner. FIGS. 38A and 38B disclose two exemplary manners in which thestructural fibers 4106 are interconnected to the longitudinal fibers4103.

Further to the above, FIG. 38A illustrates a double-looping wrap. Astructural fiber 4106 is wrapped around a first longitudinal fiber 4103,bridged over to a second longitudinal fiber 4103, and wrapped around thesecond longitudinal fiber 4103. The double-looped structural fiber 4106comprises two standing ends which comprise legs, or pillars, that arepart of a pillar wall 4109. Both loops of the structural fiber 4106comprise closed loops and/or at least one turn; however, alternativeembodiments are envisioned in which the loops each include a round turnand/or more than one turn around the longitudinal fibers 4103. Thedouble-looping wrap of FIG. 38A can also be referred to as an innerdouble-loop. More particularly, the pillars of the structural fiber 4106both pass through a gap defined between the adjacent first and secondlongitudinal fibers 4103. In various embodiments, an outer double-loopcould be utilized.

Further to the above, FIGS. 38B and 39 illustrate a structural fiber4106 wrapped around a first longitudinal fiber 4103, bridged over to asecond longitudinal fiber 4103, and wrapped around the secondlongitudinal fiber 4103. The wrap around the first longitudinal fiber4103 comprises an open loop; however, a closed loop and/or or one ormore turns could be utilized, for example. The wrap around the secondlongitudinal fiber 4103 comprises a turn; however, a round turn could beutilized, for example. Similar to the above, the structural fiber 4106of FIG. 38B comprises two standing ends which comprise legs, or pillars,that are part of a pillar wall 4109. The standing ends of the structuralfiber 4106 extend through different gaps between the longitudinal fibers4103.

Turning now to FIGS. 36 and 37 , a layer 4200 comprises longitudinalstructures or fibers 4103. The layer 4200 further comprises structuralfibers 4206 and reinforcement fibers 4107. The reinforcement fibers 4107are interweaved laterally within the longitudinal fibers 4103. Thestructural fibers 4206 are wrapped around a plurality of thelongitudinal fibers 4013 to form walls 4209. As illustrated, eachstructural fiber 4206 is wrapped around four longitudinal fibers 4103,for example, to form a wall 4209. As a result of the above, eachstructural fiber 4206 forms several closed ended loop pillars whichsupport the top portion 4205 of the layer 4200. The ends of thestructural fibers 4206 do not support the top portion 4205; however,alternative embodiments are envisioned in which the ends of thestructural fibers 4206 comprise structural pillars.

The embodiments disclosed herein can provide an organized fiber scaffoldwith compressive and bending properties interwoven with another scaffoldin a manner that forms a larger matrix which has compressive and bendingproperties in multiple orientations. Such compressive and bendingproperties can be tuned by adjusting one or more of the characteristicsdisclosed herein. The walls of the matrix can define an array of macrovoids. In various instances, the matrix can have a bi-modal nature withthe macro voids defined between walls in the matrix and interstitialspaces defined between the fibers comprising the walls. Such macro voidsand interstitial spaces can co-operate to encourage tissue ingrowth andintegration of the matrix into the body.

FIG. 40 illustrates a tissue thickness compensator or compressibleadjunct 2000. The compressible adjunct 2000 can be used with numerousdevices. In at least one embodiment, the compressible adjunct 2000 canbe employed with a surgical stapling and severing instrument 8010. Thecompressible adjunct 2000 can be attached to a staple cartridge deck 16of a staple cartridge. Alternatively, in certain instances, thecompressible adjunct 2000 can be attached to an anvil 8014.

Referring to FIG. 40 , the compressible adjunct 2000 is shown in atleast one embodiment partially compressed by tissue T. Staples 2002,which are similar in many respects to the staples 10030, engage thecompressible adjunct 2000 when the staples 2002 are fired and formed bya surgical stapling and severing instrument 8010. The formed staples2002 have a staple base 2004, first staple leg 2006, and second stapleleg 2008. In the present embodiment, the first staple leg 2006 engageswith the tissue T and compressible adjunct 2000.

The compressible adjunct 2000 includes a first portion 2012 having atissue contacting interface 2010. When the compressible adjunct 2000 isengaged by tissue T, the tissue contacting interface 2010 contacts andinteracts with tissue T. The compressible adjunct 2000 includes a secondportion 2016 having a cartridge interface 2014. In the presentembodiment, the cartridge interface 2014 can be releasably attached orpositioned on or adjacent a staple cartridge deck 16.

The compressible adjunct 2000 includes a middle portion positionedbetween the first portion 2012 and the second portion 2016. The middleportion includes a plurality of standing fiber pillars 2018 and aplurality of interconnecting fibers 2024. The standing fiber pillars2018 engage the first portion 2012 at a first portion/standing fiberpillar interface 2020. The standing fiber pillars 2018 engage the secondportion 2016 at a second portion/standing fiber pillar interface 2022.The plurality of interconnecting fibers 2024 engage the plurality ofstanding fiber pillars 2018 at a standing fiber pillar/interconnectingfiber interface 2026.

The first portion 2012 and second portion 2016 comprise variousbiocompatible materials. The first and second portions 2012, 2016 canalso be impregnated or coated with various agents, such as hemostaticagents, antibacterial agents, or antimicrobial agents, which may assistwith the recovery time of a patient. The first portion 2012 can havevarious thicknesses, and material properties. In at least oneembodiment, the first portion 2012 can have various densities andresiliencies to provide a first portion 2012 with desirable adaptiveproperties. Likewise, the second portion 2016 can have variousthicknesses and material properties. In at least one embodiment, thesecond portion 2016 can have various densities and resiliencies toprovide a second portion 2016 with desirable adaptive properties.

The standing fiber pillars 2018 comprise one or more biocompatiblematerials. A standing fiber pillar 2018 can be a resilient fiber with asuitable tensile strength and resiliency. The standing fiber pillar 2018can comprise uniform material properties and characteristics; or thematerial properties and characteristics can be varied to provide acompressible adjunct 2100 with desirable adaptive properties. In atleast one embodiment, the standing fiber pillars 2018 may be aligned inrows, and each row may have different material properties. When employedwith a surgical stapler, the standing fiber pillars 2018 positionedclosest to the knife slot of a surgical stapler or nearest an incisioncan have greater resiliency and require additional force before thestanding fiber pillar 2018 are bent or buckled. This may create anincreased pressure near the incision which may be beneficial in thetreatment of a patient. Alternatively, in certain instances, thestanding fiber pillars 2018 positioned closest to the knife slot of asurgical stapler or nearest an incision can have more elasticity andrequire less force before the standing fiber pillar 2018 are bent orbuckled.

In other embodiments, the material properties of the standing fiberpillars 2018 may be varied proximally to distally to provide desirableadaptive properties for the compressible adjunct 2000. The plurality ofstanding fiber pillars 2018 can include different densities andcross-sectional areas or diameters. When a standing fiber pillar 2018includes a relatively denser or greater cross-sectional area ordiameter, the force required to affect the desired deflection of thestanding fiber pillar 2018 may increase. Similarly, when a standingfiber pillar 2018 includes a relatively less dense or smallercross-sectional area or diameter, the force required to affect thedesired deflection may decrease. In addition, the density andcross-sectional areas or diameters of the standing fiber pillars 2018can be varied to allow the standing fiber pillars 2018 to have differentbending moments as forces increase or the compressible adjunct 2000encounters tissue T with varying thicknesses. In one such embodiment, astanding pillar fiber 2018 can have a greater density in a portioncloser to the second portion 2016 and can be less dense in a portioncloser to the first portion 2012. This may permit increased resiliencyof the compressible adjunct 2000 as additional compression forces areapplied, and the force and compression profiles vary regardingdisplacement and compression of the compressible adjunct 2000.

The standing fiber pillars 2018 engage the first portion 2012 at firstportion/standing fiber pillar interfaces 2020. The firstportion/standing fiber pillar interface 2020 can be one of a friction orresistance relationship where the standing fiber pillars 2018 are notfixably attached to the first portion 2012. In other embodiments, thestanding fiber pillars 2018 can be fixably or releasably attached to thefirst portion 2012 at the first portion/standing fiber pillar interface2020. In at least one embodiment the standing fiber pillars 2018 can beembedded in the first portion 2012. In alternative embodiments, thestanding fiber pillars 2018 can be attached, glued, welded, melted,hooked, woven, knitted, or fastened to the first portion 2012.

The standing fiber pillars 2018 engage the second portion 2016 at secondportion/standing fiber pillar interfaces 2022. The secondportion/standing fiber pillar interfaces 2022 can be one of a frictionor resistance relationship where the standing fiber pillars 2018 are notfixably attached to the second portion 2016. In other embodiments, thestanding fiber pillars 2018 can be fixably or releasably attached to thesecond portion 2016 at the second portion/standing fiber pillarinterfaces 2022. In at least one embodiment the standing fiber pillars2018 can be embedded in the second portion 2016. In alternativeembodiments, the standing fiber pillars 2018 can be attached, glued,welded, melted, hooked, woven, knitted, or fastened to the secondportion 2016.

The plurality of interconnecting fibers 2024 comprise one or morebiocompatible materials. An interconnecting fiber 2024 can be aresilient fiber with a suitable tensile strength and resiliency. Theinterconnecting fibers 2024 can comprise uniform material properties andcharacteristics; or the material properties and characteristics can bevaried to provide desirable adaptive properties for the compressibleadjunct 2000.

In at least one embodiment, the interconnecting fibers 2024 may bealigned in rows and columns to form a matrix and each row and/or columnmay have different material properties. When employed with a surgicalstapler, the interconnecting fibers 2024 positioned closest to the knifeslot of the surgical stapler or the incision can be more resilient whilethe interconnecting fibers 2024 further away from the knife slot can bemore elastic. This may create and increased pressure near the incisionwhich may be beneficial in the treatment of the patient. Alternatively,in certain instances, the interconnecting fibers 2024 positioned closestto the knife slot of the surgical stapler or the incision can be moreelastic while the interconnecting fibers 2024 further away from theknife slot can be more resilient.

In other embodiments, the material properties of the interconnectingfibers 2024 may be varied proximally to distally depending on apatient's needs. The interconnecting fibers 2024 can include differentdensities and cross-sectional areas or diameters. When aninterconnecting fiber 2024 that includes a relatively denser or greatercross-sectional area or diameter is used, the tension required to affectthe desired deflection of the interconnecting fiber 2024 increases.Similarly, when an interconnecting fiber 2024 includes a less dense orsmaller cross-section area or diameter, a tension required to affect adesired deflection of the interconnecting fiber 2024 decreases. Inaddition, the density and cross section areas or diameters of theinterconnecting fibers 2024 can be varied between a proximal portion ofthe staple cartridge 12 and a distal portion of the staple cartridge 12to allow the interconnecting fibers 2024 to have different physicalproperties and resiliency when the compressible adjunct 2000 encounterstissue T with varying thicknesses.

The standing fiber pillars 2018 and the interconnecting fibers 2024engage one another at the standing fiber pillar/interconnecting fiberinterfaces 2026. The standing fiber pillar/interconnecting fiberinterfaces 2026 can be one of a friction or resistance relationshipwhere the standing fiber pillars 2018 are not fixably attached to theinterconnecting fibers 2024. In other embodiments, the standing fiberpillar 2018 can be fixably, releasably, or slidably attached to theinterconnecting fibers 2024 at the standing fiber pillar/interconnectingfiber interfaces 2026. In at least one embodiment, the standing fiberpillars 2018 can be embedded in the interconnecting fibers 2024. Inalternative embodiments, the standing fiber pillars 2018 can beattached, glued, welded, melted, hooked, woven, looped, or fastened tothe interconnecting fibers 2024.

The interconnecting fibers 2024 can also create additional stability foreach standing fiber pillar 2018 and for the overall compressible adjunct2000. Referring again to FIG. 40 , the interconnecting fibers 2024 arespaced apart between the first portion 2012 and the second portion 2016.Three interconnecting fibers 2024 are engaged with each standing fiberpillar 2018 spaced substantially equidistance from each other; however,any suitable number of interconnecting fibers 2024 can be employed. Inother embodiments, the number of interconnecting fibers 2024 can beincreased to increase the stability of the standing fiber pillars 2018or to increase the resiliency and force required to compress thecompressible adjunct 2000. In another embodiment, the spacing and thequantity of interconnecting fibers 2024 can be adjusted to provide acompressible adjunct 2000 with desirable adaptive properties. When theinterconnecting fibers 2024 are positioned closer to the second portion2016, the compressible adjunct 2000 has a higher stiffness in theportion of the compressible adjunct 2000 nearest the second portion 2016and a lesser stiffness in the portion of the compressible adjunct 2000nearest the first portion 2012.

Referring to FIG. 41 , a compressible adjunct 2100 is shown in at leastone embodiment partially compressed by tissue T. Staples 2102 engage thecompressible adjunct 2100 when the staples 2102 are fired and formed bya surgical stapler. The formed staples 2102 have a staple base 2104,first staple leg 2106, and second staple leg 2108. In the presentembodiment, the first staple leg 2106 engages the tissue T andcompressible adjunct 2100.

The compressible adjunct 2100 includes a first portion 2112 having atissue contacting interface 2110. When the compressible adjunct 2100engages tissue T, the tissue contacting interface 2110 contacts andinteracts with tissue T. The compressible adjunct 2100 includes a secondportion 2116 having a cartridge interface 2114. The cartridge interface2114 can be releasably attached or positioned on or adjacent a staplecartridge deck 16.

The compressible adjunct 2100 includes a middle portion positionedbetween the first portion 2112 and the second portion 2116. The middleportion includes a plurality of standing fiber pillars 2118 and aninterconnecting fiber 2124; however any suitable number ofinterconnecting fibers 2124 can be used. The standing fiber pillars 2118engage the first portion 2112 at a first portion/standing fiber pillarinterface 2120. The standing fiber pillars 2118 engage the secondportion 2116 at a second portion/standing fiber pillar interface 2122.The interconnecting fiber 2124 engages the plurality of standing fiberpillars 2118 at a standing fiber pillar/interconnecting fiber interface2126.

The first portion 2112 and second portion 2116 comprise one or morebiocompatible materials. The first and second portions 2112, 2116 canalso be impregnated or coated with various agents, such as hemostaticagents, antibacterial agents, or antimicrobial agents, which may assistwith the recovery time of a patient. The first portion 2112 can havevarious thicknesses, and material properties. In at least oneembodiment, the first portion 2112 can have various densities andresiliencies to provide a first portion 2112 with desirable adaptiveproperties. Likewise, the second portion 2116 can have variousthicknesses and material properties. In at least one embodiment, thesecond portion 2116 can have various densities and resiliencies toprovide a second portion 2116 with desirable adaptive properties.

The standing fiber pillars 2118 comprise one or more biocompatiblematerials. A standing fiber pillar 2118 can be a resilient fiber with asuitable tensile strength and resiliency. The standing fiber pillars2118 can comprise uniform material properties and characteristics; orthe material properties and characteristics can be varied to provide acompressible adjunct 2100 with desirable adaptive properties. In atleast one embodiment, the standing fiber pillars 2118 may be aligned inrows and each row may have different material properties. When employedwith a surgical stapler, the standing fiber pillars 2118 positionedclosest to the knife slot of a surgical stapler or nearest an incisioncan have greater resiliency and require additional force before thestanding fiber pillar 2118 are bent or buckled. This may create anincreased pressure near the incision which may be beneficial in thetreatment of a patient. Alternatively, in certain instances, thestanding fiber pillars 2118 positioned closest to the knife slot of asurgical stapler or nearest an incision can have more elasticity andrequire less force before the standing fiber pillar 2118 are bent orbuckled.

In other embodiments, the material properties of the standing fiberpillars 2118 may be varied proximally to distally to provide desirableadaptive properties for the compressible adjunct 2100. The plurality ofstanding fiber pillars 2118 can include different densities andcross-sectional areas or diameters. When a standing fiber pillar 2118includes a relatively denser or greater cross-sectional area ordiameter, the force required to affect the desired deflection of thestanding fiber pillar 2118 may increase. Similarly, when a standingfiber pillar 2118 includes a relatively less dense or smallercross-sectional area or diameter, the force required to affect thedesired deflection may decrease. In addition, the density andcross-sectional areas or diameters of the standing fiber pillars 2118can be varied to allow the standing fiber pillars 2118 to have differentbending moments as forces increase or the compressible adjunct 2100encounters tissue T with varying thicknesses. In one such embodiment, astanding pillar fiber 2118 can have a greater density in a portioncloser to the second portion 2116 and can be less dense in a portioncloser to the first portion 2112. This may permit increased resiliencyof the compressible adjunct 2100 as additional compression forces areapplied, and the force and compression profiles vary regardingdisplacement and compression of the compressible adjunct 2100.

The standing fiber pillars 2118 engage the first portion 2112 at firstportion/standing fiber pillar interfaces 2120. The firstportion/standing fiber pillar interface 2120 can be one of a friction orresistance relationship where the standing fiber pillars 2118 are notfixably attached to the first portion 2112. In other embodiments, thestanding fiber pillars 2118 can be fixably or releasably attached to thefirst portion 2112 at the first portion/standing fiber pillar interface2120. In at least one embodiment the standing fiber pillars 2118 can beembedded in the first portion 2112. In alternative embodiments, thestanding fiber pillars 2118 can be attached, glued, welded, melted,hooked, woven, knitted, or fastened to the first portion 2112.

The standing fiber pillars 2118 engage the second portion 2116 at secondportion/standing fiber pillar interfaces 2122. The secondportion/standing fiber pillar interfaces 2122 can be one of a frictionor resistance relationship where the standing fiber pillars 2118 are notfixably attached to the second portion 2116. In other embodiments, thestanding fiber pillars 2118 can be fixably or releasably attached to thesecond portion 2116 at the second portion/standing fiber pillarinterfaces 2122. In at least one embodiment the standing fiber pillars2118 can be embedded in the second portion 2116. In alternativeembodiments, the standing fiber pillars 2118 can be attached, glued,welded, melted, hooked, woven, knitted, or fastened to the secondportion 2116.

The interconnecting fiber 2124 comprises one or more biocompatiblematerials. The interconnecting fiber 2124 can be a resilient fiber witha suitable tensile strength and resiliency. The interconnecting fiber2124 can comprise uniform material properties and characteristics; orthe material properties and characteristics can be to provide desirableadaptive properties for the compressible adjunct 2100.

In other embodiments, the material properties of the interconnectingfiber 2124 may be varied proximally to provide desirable adaptiveproperties. The interconnecting fiber 2124 can include differentdensities and cross sectional areas.

When an interconnecting fiber 2124 that includes a relatively denser orgreater cross-sectional area or diameter is used, the tension requiredto affect the desired deflection of the interconnecting fiber 2124increases. Similarly, when an interconnecting fiber 2124 includes a lessdense or smaller cross-section area or diameter, a tension required toaffect a desired deflection of the interconnecting fiber 2024 decreases.In addition, the density and cross section area or diameter of theinterconnecting fiber 2124 can be varied between a proximal portion ofthe staple cartridge 12 and a distal portion of the staple cartridge 12to allow the interconnecting fiber 2124 to have different physicalproperties and resiliency when the compressible adjunct 2100 encounterstissue T with varying thicknesses.

The standing fiber pillars 2118 and the interconnecting fiber 2124engage one another at the standing fiber pillar/interconnecting fiberinterface 2126. The standing fiber pillar/interconnecting fiberinterface 2126 can be one of a friction or resistance relationship wherethe standing fiber pillars 2118 are not fixably attached to theinterconnecting fiber 2124. In other embodiments, the standing fiberpillar 2118 can be fixably, releasably, or slidably attached to theinterconnecting fiber 2124 at the standing fiber pillar/interconnectingfiber interface 2126. In at least one embodiment, the standing fiberpillars 2118 can be embedded in the interconnecting fiber 2124. Inalternative embodiments, the standing fiber pillars 2118 can beattached, glued, welded, melted, hooked, knitted, woven, looped, orfastened to the interconnecting fiber 2124.

The interconnecting fiber 2124 can also create additional stability forthe overall compressible adjunct 2100 and for each standing fiber pillar2118. Referring again to FIG. 41 , a single interconnecting fiber 2124is spaced between the first portion 2112 and the second portion 2116.The single interconnecting fiber 2124 engages each standing fiber pillar2118 substantially at the midpoint of the standing fiber pillars 2118.In other embodiments, the number of interconnecting fibers 2124 can beincreased to increase the stability of the standing fiber pillars 2118or to increase the resiliency and force required to compress thecompressible adjunct 2100. In another embodiment, spacing ofinterconnecting fiber 2124 can be adjusted to provide a compressibleadjunct 2100 with desirable adaptive properties. When theinterconnecting fiber 2124 is positioned closer to the second portion2116, the compressible adjunct 2100 has a higher stiffness in theportion of the compressible adjunct 2100 nearest the second portion 2116and a lesser stiffness in the portion of the compressible adjunct 2100nearest the first portion 2112.

Referring to FIG. 41 , the interface 2126 can be in the form of slipjoints that permit the interconnecting fiber 2124 to slip, move, and/orshift between the standing fiber pillars 2118. This feature allows thestanding fiber pillar 2118 to freely bend to different degrees whilemaintaining a coupling engagement with the other standing fiber pillars2118 through the slip joint interface defined by the interconnectingfiber 2124.

Referring to FIG. 42 , a compressible adjunct 2200 is depicted. Thecompressible adjunct 2200 is engaged with tissue T having various tissuethicknesses. Tissue T has a first tissue thickness T1 and a secondtissue thickness T2. At least one Staple 2202 engages the compressibleadjunct 2200. The staple 2202 has a staple base 2204, and a first stapleleg 2206 and a second staple leg 2208 extending from the staple base2204. The staple 2202 is formed and a portion of the first staple leg2206 and second staple leg 2208 engage tissue T and the compressibleadjunct 2200.

The compressible adjunct 2200 includes a tissue contacting interface2210 configured to interact with adjacent tissue T. The compressibleadjunct 2200 can be used with various surgical procedures and can beemployed in surgical staplers or staple cartridges. The compressibleadjunct 2200 includes a cartridge interface 2214 that can rest or befixably attached to a deck 16 of a staple cartridge 12. The compressibleadjunct 2200 can include a plurality of standing fiber support portions2214 and a compressible adjunct base portion 2216. The plurality ofstanding fiber support portions 2214 can extend from the compressibleadjunct base portion 2216.

The compressible adjunct 2200 is engaged with tissue T having variousthicknesses, T1, T2. In response to the tissue thicknesses, thecompressible adjunct 2200 is compressed to a first compressed height H1and a second compressed height H2. In the present embodiment, thecompressible adjunct 2200 is responsive and conforming regarding tissueT having varying thicknesses. The compressible adjunct 2200 comprisesone or more biocompatible materials.

The standing fiber support portions 2214 can be adapted and configuredto have various material properties. The standing fiber support portions2214 can have various densities, cross section areas and diameters, andporosities. The standing fiber support portions 2214 can includemultiple woven or twisted fibers in each standing fiber support portion2214. These individual fibers can have various densities, cross sectionareas and diameters, and porosities. Each standing fiber support portion2214 contains at least two twisted fibers and is fixably attached to thecompressible adjunct base portion 2214. Alternatively, the standingfiber support portions 2214 can be releasably or slidably attached tothe compressible adjunct base portion 2216. In at least one embodiment,the standing fiber support portions 2214 can be embedded in thecompressible adjunct base portion 2216. In alternative embodiments, thestanding fiber support portions 2214 can be attached, glued, welded,melted, hooked, woven, knitted, looped, or fastened to the compressibleadjunct base portion 2216.

In at least one embodiment, each standing fiber support portion 2214 caninclude at least two fibers twisted or mated together. The twistedfibers can be adjusted to affect the desired resiliency andcompressibility of the compressible adjunct 2200. In at least oneembodiment, the fibers of the standing fiber support portion 2214 can bemore tightly twisted or wound at a portion of the standing fiber supportportion 2214 near the compressible adjunct base portion 2216. Similarly,the fibers of the standing fiber support portion 2214 can be moreloosely twisted or wound at a portion of the standing fiber supportportion 2214 near the tissue contacting interface 2210. The variabletightness of the fibers of the standing fiber support portions 2214permits different compressibility of the compressible adjunct 2200. Inanother embodiment, the fibers of the standing fiber support portions2214 can be configured to untwist or unwind when the compressibleadjunct 2200 encounters tissue having a greater thickness or thestanding fiber support portions 2214 encounter greater resistance.

In another embodiment, the axial strength of the standing fiber supportportions 2214 can be adjusted and adapted to provide desirable adaptiveproperties for the compressible adjunct 2200. The standing fiber supportportions 2214 can also create a dynamic system where the fibers of thestanding fiber support portions 2214 may unravel closer to the tissuecontacting interface 2210 and compress near the compressible adjunctbase portion 2216. The dynamic system permits the compressible adjunct2200 to dynamically interact with tissue having varying thicknesses.When the standing fiber support portions 2214 engage a portion of tissuehaving a greater thickness, they can adaptively adjust to permit greatercompressibility of the compressible adjunct 2200. Where the standingfiber support portions 2214 engage a portion of tissue having a thinnerthickness, the compressible adjunct 2200 can remain more rigid tocompensate for the varying tissue thickness. The dynamic ability toadjust to tissue having varying thicknesses helps facilitate properstaple formation and compression to secure the engaged tissue T.

Referring to FIG. 43 , a fiber 2300 is depicted. The fiber 2300 can havevarious material and physical properties and can be made to differentshapes, sizes and lengths. As illustrated in FIG. 43 , the fiber 2300comprises a cylindrical, or at least substantially cylindrical, shape.In other embodiments, the fiber 2300 may have a square, rectangular,oval, octagonal, or any other transverse cross-sectional shape. Thefiber 2300 can be flexible and elastic and can be used in manufacturingvarious compressible adjuncts of the present disclosure. The fiber 2300comprises one or more biocompatible materials.

The material composition, height, and/or transverse cross-sectional areaof the fiber 2300 affect its stiffness or ability to bend undercompression. The stiffness of the fiber 2300 can be adjusted to tune thecompressibility of a compressible adjunct to one or more desired values.

Referring to FIG. 44 , a fiber 2400 is depicted. The fiber 2400 hasundergone a gas sorption process. The gas sorption process impregnates afiber inner portion 2406 of the fiber 2400 with a plurality of fiberinner pores 2408. An outer fiber surface 2402 of the fiber 2400 can alsobe transformed through the gas sorption process to include a pluralityof outer fiber surface pores 2404.

Batch foaming through a gas sorption process includes selecting asubstrate or fiber 2400 to be used. The method further includes forcinggas into the fiber 2400 or substrate at elevated pressures. Then thepressure is dropped and, as a result, the subjected fiber 2400 orsubstrate may expand. The expanded fiber 2400 or substrate can have anincreased porosity, a reduced density, and/or increased cross sectionsurface area and diameter. The gas sorption process may be advantageousover other conventional methods as it permits the adjustment and tuningof the material characteristics such as, for example, the stiffness of afiber 2400 without requiring chemical solvents.

A gas sorption batch foaming process can be applied to varioussubstrates. In at least one embodiment, the gas sorption batch foamingmethod may be applied to biocompatible polymer films that can be used asan implantable device or compressible adjunct. Gas at elevated pressurescan be forced into the polymer films. Then the polymer films can beexpanded into a closed cell construct by dropping the pressure. Thepolymer film can become a compressible closed cell structure withoutrequiring chemical solvents.

Another desirable substrate for the gas sorption process includesmelt-blown non-woven constructs. In various instances, a melt blowingprocess comprises extruding a molten polymer through orifices, andattenuating the extrudates into fibers by action of ahigh-temperature/high-speed gas that blows the molten polymer from nearthe orifices onto a conveyer or a take-up screen to form fibrousnon-woven constructs.

The melt-blown non-woven constructs rapidly increase in stiffness asthey increase in thickness. In certain instances, a compressible adjunctwith a greater thickness is desired without the accompanying increase instiffness. This presents a limitation of the melt blowing process. Incertain instances, a compressible adjunct with a greater thickness andsuitable stiffness can be obtained using chemical solvents.

Referring to FIG. 45 , a compressible adjunct 2500 comprising a greaterthickness and suitable stiffness is produced without resorting tochemical solvents. The compressible adjunct 2500 is made through a meltblowing process that yields a melt-blown non-woven intermediatesubstrate with a plurality of fibers 2501. The melt-blown non-wovenintermediate substrate is further processed by a gas sorption process toyield a suitable stiffness. By further processing the melt-blownnon-woven substrate through a gas sorption process, the intermediatesubstrate can be expanded and the density, compressibility, and/orporosity can be adjusted to desired parameters.

The melt-blown non-woven intermediate substrate is produced using a meltblowing process. Other suitable techniques can be employed to produce asuitable substrate for the gas sorption process. In at least oneinstance, an electro-spinning process can be used. In at least oneinstance, a substrate can be produced by knitting, weaving, or any othersuitable process.

One or more of the compressible adjuncts of the present disclosure canbe modified by a gas sorption process to adjust their densities,compressibilities, and/or porosities to desired parameters. Variouspillars, spacer fibers, standing fibers, and/or looping members of thecompressible adjuncts of the present disclosure can be modified by a gassorption process to adjust their densities, compressibilities, and/orporosities to desired parameters.

Referring to FIG. 45 , the gas sorption process may cause outer fibersurfaces 2502 to form outer fiber surface pores 2504. In addition, thegas sorption process can impregnate a fiber inner portion 2506 with aplurality of fiber inner pores 2508. Through the gas sorption process,the intermediate substrate can be expanded in volume while decreasingthe density and increasing the porosity of the substrate. Some potentialbenefits of the combination process may include greater tissue ingrowthinto a compressible adjunct 2500 due to the greater porosity achieved bycombining the melt blowing process and the gas sorption process. Thecompressible adjunct 2500, as illustrated in FIG. 45 , includes aplurality of pores 2510 generated between the fibers 2501 in the meltblowing process in addition to the pores generated by the gas sorptionprocess within the individual fibers 2501.

Once the compressible adjunct 2500 is formed to the desirablecharacteristics, further processing may be done. In at least oneembodiment, multiple compressible adjuncts 2500 may be layered toincrease the thickness of the overall construct or add differentmaterial characteristics. In at least one embodiment, compressibleadjuncts 2500 made of different materials or of different porosities anddensities may be used. In one example, the density and porosity nearer atissue interface may be greater to allow greater tissue ingrowth.Multiple compressible adjuncts can be attached through melting,fastening, gluing, knitting, weaving, hooking, and other attachmenttechniques.

The compressible adjunct 2500 can be further enhanced through coating orembedding the compressible adjunct 2500 with various substances. In atleast one embodiment, it may be beneficial to coat or impregnate thecompressible adjunct 2500 with hemostatic agents, antibacterial agents,or antimicrobial agents.

Various embodiments are disclosed including adjuncts attached to and/orpositioned on a staple cartridge. It should be understood that suchteachings are applicable to embodiments in which an adjunct is attachedto and/or positioned on an anvil of a surgical instrument. In fact,embodiments are envisioned in which a first adjunct is attached toand/or positioned on a cartridge and a second adjunct is attached toand/or positioned on an anvil.

The compressible adjuncts of the present disclosure can be positionedagainst a cartridge deck of a staple cartridge such as, for example, thecartridge deck 16 of the staple cartridge 12. In at least one instance,a compressible adjunct can be positioned against a cartridge deck of astaple cartridge prior to loading the staple cartridge onto a surgicalinstrument such as, for example, the surgical stapling and severinginstrument 8010 (FIG. 1 ). Alternatively, a compressible adjunct can bepositioned against a cartridge deck of a staple cartridge after thestaple cartridge has been loaded into the surgical stapling and severinginstrument. A loading unit can be employed to deposit a compressibleadjunct onto the cartridge deck of the staple cartridge. The loadingunit may include various attachment features and/or placement featuresfor manipulating and positioning the compressible adjunct against thecartridge deck. Once the compressible adjunct is correctly positionedagainst the cartridge deck, the loading unit can release thecompressible adjunct.

Further to the above, a compressible adjunct can be positioned against acartridge deck without attachment to the staple cartridge.Alternatively, a compressible adjunct can be attached to the staplecartridge prior to or after the staple cartridge is loaded into thesurgical stapling and severing instrument. For example, the compressibleadjunct can be partially melted onto the cartridge deck thenresolidified by cooling which causes the compressible adjunct to bond tothe cartridge deck. Various attachment features can also be employed toattach a compressible adjunct to a staple cartridge such as, forexample, sutures, straps, barbs, and/or other mechanical attachmentmechanisms.

EXAMPLES

Example 1—A compressible adjunct for use with a surgical instrumentincluding a staple cartridge, wherein the compressible adjunct comprisesa first biocompatible layer, a second biocompatible layer spaced apartfrom the first biocompatible layer, and a plurality of supportingpillars extending between the first biocompatible layer and the secondbiocompatible layer.Example 2—The compressible adjunct of Example 1, wherein each of thesupporting pillars comprises a first end portion attached to the firstbiocompatible layer and a second end portion attached to the secondbiocompatible layer.Example 3—The compressible adjunct of Example 2, wherein the first endportion and the second end portion define a transverse axis intersectingthe first biocompatible layer and the second biocompatible layer.Example 4—The compressible adjunct of Example 3, wherein the transverseaxis defines a first angle with the first biocompatible layer, whereinthe transverse axis defines a second angle with the second biocompatiblelayer, and wherein the first angle and the second angle are selectedfrom a range of about 80° to a about 100°.Example 5—The compressible adjunct of Examples 2, 3, or 4, wherein thefirst end portion is woven into the first biocompatible layer.Example 6—The compressible adjunct of Examples 2, 3, 4, or 5, whereinthe first end portion is welded to the first biocompatible layer.Example 7—The compressible adjunct of Examples 1, 2, 3, 4, 5, or 6,wherein the plurality of supporting pillars comprises a first supportingpillar and a second supporting pillar crossing the first supportingpillar.Example 8—The compressible adjunct of Examples 1, 2, 3, 4, 5, 6, or 7,wherein at least one of the first biocompatible layer and the secondbiocompatible layer comprises a woven matrix.Example 9—The compressible adjunct of Examples 1, 2, 3, 4, 5, 6, 7 or 8,wherein at least one of the first biocompatible layer and the secondbiocompatible layer comprises a knitted matrix.Example 10—The compressible adjunct of Examples 1, 2, 3, 4, 5, 6, 8 or9, wherein at least one of the first biocompatible layer and the secondbiocompatible layer comprises a film.Example 11—The compressible adjunct of Examples 1, 2, 3, 4, 5, 6, 8, 9,or 10, wherein the second biocompatible layer comprises an outer surfaceconfigured to grip tissue.Example 12—The compressible adjunct of Example 11, wherein the outersurface comprises a plurality of gripping features, and wherein each ofthe gripping features defines an acute angle with the outer surface.Example 13—The compressible adjunct of Examples 1, 2, 3, 4, 5, 6, 8, 9,10, 11, or 12, wherein the first biocompatible layer comprises a greaterdensity than the second biocompatible layer.Example 14—The compressible adjunct of Examples 1, 2, 3, 4, 5, 6, 8, 9,10, 11, 12, or 13, further comprising a body portion and an outer edgeat least partially surrounding the body portion, wherein the bodyportion comprises a greater thickness than the outer edge.Example 15—The compressible adjunct of Example 14, wherein the outeredge is tapered.Example 16—The compressible adjunct of Examples 14 or 15, wherein theouter edge comprises a first outer edge portion extending from the firstbiocompatible layer and a second outer edge portion extending from thesecond biocompatible layer, wherein the first outer edge portion and thesecond outer edge portion are united into a continuous side portionconfigured to join the first biocompatible layer and the secondbiocompatible layer.Example 17—The compressible adjunct of Examples 1, 2, 3, 4, 5, 6, 8, 9,10, 11, 12, 13, 14, 15, or 16, further comprising a knife slotconfigured to receive a knife for cutting tissue captured by thesurgical instrument, wherein the knife slot defines two sides, andwherein the knife passes between the two sides.Example 18—The compressible adjunct of Example 17, further comprising atether extending between the two sides, wherein the knife is configuredto cut the tether to separate the two sides.Example 19—A staple cartridge assembly for use with a surgical staplinginstrument, wherein the staple cartridge assembly comprises a staplecartridge comprising a plurality of staples and a cartridge deckcomprising an outer surface. The staple cartridge assembly furthercomprises a compressible adjunct positionable against the outer surface,wherein the compressible adjunct comprises a tissue-facing biocompatiblelayer, a deck-facing biocompatible layer positionable against the outersurface, wherein the tissue-facing biocompatible layer is spaced apartfrom the deck-facing biocompatible layer, and spacer fibers intersectingthe tissue-facing biocompatible layer and the deck-facing biocompatiblelayer, wherein the spacer fibers are configured to lift thetissue-facing biocompatible layer over the deck-facing biocompatiblelayer.Example 20—A compressible adjunct for use with a surgical instrumentincluding a staple cartridge, wherein the compressible adjunct comprisesa first biocompatible layer, a second biocompatible layer spaced apartfrom the first biocompatible layer, and an elongate flexible memberinterconnecting the first biocompatible layer and the secondbiocompatible layer, wherein the elongate flexible member is configuredto form a plurality of supporting structures standing between the firstbiocompatible layer and the second biocompatible layer.Example 21—A staple cartridge assembly for use with a surgical staplinginstrument, wherein the staple cartridge assembly comprises a staplecartridge comprising a plurality of staples and a cartridge deck. Thestaple cartridge assembly further comprises a compressible adjunctpositionable against the cartridge deck, wherein the staples aredeployable into tissue captured against the compressible adjunct, andwherein the compressible adjunct comprises a first biocompatible layercomprising a first portion, a second biocompatible layer comprising asecond portion, and crossed spacer fibers extending between the firstportion and the second portion.Example 22—A staple cartridge assembly for use with a surgical staplinginstrument, wherein the staple cartridge assembly comprises a staplecartridge comprising a plurality of staples and a cartridge deck. Thestaple cartridge assembly further comprises a compressible adjunctpositionable against the cartridge deck, wherein the staples aredeployable into tissue captured against the compressible adjunct, andwherein the compressible adjunct comprises a tissue-facing layercomprising a first bonding node and a second bonding node arranged in afirst row with the first bonding node. The compressible adjunct furthercomprises a deck-facing layer, wherein the tissue-facing layer is spacedapart from the deck-facing layer, and wherein the deck-facing layercomprises a third bonding node vertically aligned with the first bondingnode and a fourth bonding node vertically aligned with the secondbonding node, wherein the fourth bonding node is arranged in a secondrow with the third bonding node. The compressible adjunct furthercomprises a first spacer fiber extending between the first bonding nodeand the fourth bonding node and a second spacer fiber extending betweenthe second bonding node and the third bonding node, wherein the firstspacer fiber crosses the second spacer fiber.Example 23—The staple cartridge assembly of Example 22, wherein thefirst row is parallel to the second row.Example 24—The staple cartridge assembly of Examples 22 or 23, whereinthe first row further comprises a fifth bonding node between the firstbonding node and the second bonding node.Example 25—The staple cartridge assembly of Example 24, furthercomprising a first fiber portion interconnecting the first bonding nodeand the fifth bonding node.Example 26—The staple cartridge assembly of Examples 24 or 25, furthercomprising a second fiber portion interconnecting the second bondingnode and the fifth bonding node.Example 27—The staple cartridge assembly of Examples 22, 23, 24, 25, or26, wherein the second row further comprises a sixth bonding nodebetween the third bonding node and the fourth bonding node.Example 28—The staple cartridge assembly of Example 27, furthercomprising a third fiber portion interconnecting the third bonding nodeand the sixth bonding node.Example 29—The staple cartridge assembly of Examples 27 or 28, furthercomprising a fourth fiber portion interconnecting the fourth bondingnode and the sixth bonding node.Example 30—The staple cartridge assembly of Examples 27, 28, or 29,wherein the fifth bonding node is vertically aligned with the sixthbonding node.Example 31—A staple cartridge assembly for use with a surgical staplinginstrument, wherein the staple cartridge assembly comprises a staplecartridge comprising a plurality of staples and a cartridge deckdefining a proximal end and a distal end. The staple cartridge assemblyfurther comprises a compressible adjunct positionable against thecartridge deck, wherein the staples are deployable into tissue capturedagainst the compressible adjunct, and wherein the compressible adjunctcomprises a tissue-facing layer comprising a first bonding node and asecond bonding node arranged in a first row with the first bonding node.The compressible adjunct further comprises a deck-facing layer, whereinthe tissue-facing layer is spaced apart from the deck-facing layer, andwherein the deck-facing layer comprises a third bonding node and afourth bonding node, wherein the fourth bonding node is arranged in asecond row with the third bonding node. The compressible adjunct furthercomprises a first spacer fiber extending from the first bonding node tothe third bonding node, a second spacer fiber extending from the firstbonding node toward the deck-facing surface in a proximal direction, anda third spacer fiber extending from the first bonding node toward thedeck-facing surface in a distal direction. The compressible adjunctfurther comprises a fourth spacer fiber extending from the secondbonding node to the fourth bonding node.Example 32—The staple cartridge assembly of Example 31, furthercomprising a fifth spacer fiber extending from the second bonding nodetoward the deck-facing surface in the proximal direction.Example 33—The staple cartridge assembly of Examples 31 or 32, furthercomprising a sixth spacer fiber extending from the second bonding nodetoward the deck-facing surface in the distal direction.Example 34—The staple cartridge assembly of Example 33, wherein thesixth spacer fiber crosses the second spacer fiber.Example 35—The staple cartridge assembly of Examples 31, 32, 33, or 34,further comprising a seventh spacer fiber extending from the firstbonding node to the third bonding node.Example 36—The staple cartridge assembly of Examples 31, 32, 33, 34, or35, further comprising an eighth spacer fiber extending from the secondbonding node to the fourth bonding node.Example 37—The staple cartridge assembly of Examples 31, 32, 33, 34, 35,or 36, wherein the first bonding node is vertically aligned with thethird bonding node.Example 38—The staple cartridge assembly of Examples 31, 32, 33, 34, 35,36, or 37, wherein the second bonding node is vertically aligned withthe fourth bonding node.Example 39—A staple cartridge assembly for use with a surgical staplinginstrument, wherein the staple cartridge assembly comprises a staplecartridge comprising a plurality of staples and a cartridge deckdefining a proximal end and a distal end. The staple cartridge assemblyfurther comprises a compressible adjunct positionable against thecartridge deck, wherein the staples are deployable into tissue capturedagainst the compressible adjunct, and wherein the compressible adjunctcomprises a tissue-facing layer and a deck-facing layer, wherein thetissue-facing layer is spaced apart from the deck-facing layer, andwherein the deck-facing layer comprises an outer surface and an innersurface. The compressible adjunct further comprises a first spacer fiberextending from the tissue-facing layer toward the inner surface, asecond spacer fiber extending from the tissue-facing layer toward theinner surface, wherein the first spacer fiber and the second spacerfiber extend through the deck-facing layer, and a loop defined by thefirst spacer fiber and the second spacer fiber on the outer surface.Example 40—The staple cartridge assembly of Example 39, wherein thefirst spacer fiber and the second spacer fiber intersect at thedeck-facing layer.Example 41—The staple cartridge assembly of Examples 39 or 40, furthercomprising a third spacer fiber extending from the tissue-facing layer,wherein the third spacer fiber intersects the first spacer fiber and thesecond spacer fiber at the deck-facing layer.Example 42—A compressible adjunct for use with a surgical instrumentincluding a staple cartridge, wherein the compressible adjunct comprisesa biocompatible layer and a plurality of biocompatible looping membersprotruding from the biocompatible layer. Each of the biocompatiblelooping members comprises a first end portion attached to thebiocompatible layer, a second end portion attached to the biocompatiblelayer, and an intermediate curved portion extending between the firstend portion and the second end portion, wherein the intermediate curvedportion is further away from the biocompatible layer than the first endportion and the second end portion.Example 43—The compressible adjunct of Example 42, further comprisinganother biocompatible layer spaced apart from the biocompatible layer.Example 44—The compressible adjunct of Example 43, wherein the pluralityof biocompatible looping members is positioned between the biocompatiblelayer and the another biocompatible layer.Example 45—The compressible adjunct of Examples 43 or 44, wherein theintermediate curved portion is attached to the another biocompatiblelayer.Example 46—The compressible adjunct of Examples 43, 44, or 45, whereinthe another biocompatible layer comprises a woven layer.Example 47—The compressible adjunct of Examples 42, 43, 44, 45, or 46,wherein the biocompatible layer comprises a plurality of tetheringislands that are spaced apart from one another, and wherein each of thetethering islands is defined by the first end portion and the second endportion of at least one of the biocompatible looping members.Example 48—The compressible adjunct of Example 47, wherein the tetheringislands are arranged in parallel rows.Example 49—The compressible adjunct of Examples 42, 43, 44, 45, 46, or47, wherein each of the biocompatible looping members comprises a widehead portion and narrow neck portion extending between the wide headportion and the biocompatible layer.Example 50—The compressible adjunct of Examples 42, 43, 44, 45, 46, 47,or 48, wherein each of the biocompatible looping members is comprised ofa fiber.Example 51—The compressible adjunct of Example 50, wherein the fiber isa multifilament fiber.Example 52—The compressible adjunct of Examples 42, 43, 44, 45, 46, 47,48, 49, 50, or 51, wherein the biocompatible looping members areconfigured to bend in a disorganized manner in response to a compressionforce.Example 53—The compressible adjunct of Examples 42, 43, 44, 45, 46, 47,48, 49, 50, or 51, wherein the biocompatible looping members areconfigured to bend in an organized manner in response to a compressionforce.Example 54—A compressible adjunct for use with a surgical instrumentincluding a staple cartridge, wherein the compressible adjunct comprisesa first biocompatible layer comprising first fiber loops arranged in aplurality of first rows, a second biocompatible layer spaced apart fromthe first biocompatible layer, wherein the second biocompatible layercomprises second fiber loops arranged in a plurality of second rowsspaced apart from the plurality of first rows, and a pair of first fiberportions extending from each of the first fiber loops toward the secondbiocompatible layer. The compressible adjunct further comprises a pairof second fiber portions extending from each of the second fiber loopstoward the first biocompatible layer.Example 55—The compressible adjunct of Example 54, wherein the firstfiber portions are slanted to favor bending in a first direction inresponse to a compression force.Example 56—The compressible adjunct of Example 55, wherein the secondfiber portions are slanted to favor bending in the first direction inresponse to the compression force.Example 57—The compressible adjunct of Examples 54, 55, or 56, whereinthe first fiber portions and the second fiber portions are configured tobend in a disorganized manner in response to a compression force.Example 58—The compressible adjunct of Examples 54, 55, or 56, whereinthe first fiber portions and the second fiber portions are configured tobend in an organized manner in response to a compression force.Example 59—A staple cartridge assembly for use with a surgical staplinginstrument, wherein the staple cartridge assembly comprises a staplecartridge comprising a plurality of staples and a cartridge deckdefining a proximal end and a distal end. The staple cartridge assemblyfurther comprises a compressible adjunct positionable against thecartridge deck, wherein the compressible adjunct comprises a firstbiocompatible layer and a second biocompatible layer spaced apart fromthe first biocompatible layer. The second biocompatible layer comprisesa first fiber loop, a pair of first fiber portions extending from thefirst fiber loop toward the first biocompatible layer, a second fiberloop proximal to the first fiber loop, wherein the pair of first fiberportions passes through the second fiber loop, and a pair of secondfiber portions extending from the second fiber loop toward the firstbiocompatible layer.Example 60—The staple cartridge assembly of Example 59, wherein thesecond biocompatible layer comprises a third fiber loop proximal to thesecond fiber loop, wherein the pair of second fiber portions passesthrough the third fiber loop and a pair of third fiber portionsextending from the third fiber loop toward the first biocompatiblelayer.Example 61—The staple cartridge assembly of Examples 59 or 60, whereinthe second layer is a knitted layer.Example 62—A staple cartridge assembly comprising a cartridge bodycomprising a deck and a plurality of staple cavities defined in thedeck, a plurality of staples removably stored in the staple cavities,and an implantable layer positioned over the staple cavities, whereinthe implantable layer comprises structural fibers weaved into a topsurface, a bottom surface, and pillar walls extending between the topsurface and the bottom surface and reinforcement fibers interwovenwithin the pillar walls.Example 63—The staple cartridge assembly of Example 62, wherein thereinforcement fibers are interwoven within the top surface and thebottom surface.Example 64—The staple cartridge assembly of Examples 62 or 63, whereinthe reinforcement fibers are looped around the structural fibers.Example 65—The staple cartridge assembly of Examples 62, 63, or 64,wherein the implantable layer comprises a first compression zonecomprising a first density of loops between the reinforcement fibers andthe structural fibers and a second compression zone comprises a seconddensity of loops between the reinforcement fibers and the structuralfibers, wherein the second density is greater than the first density.Example 66—The staple cartridge assembly of Example 65, wherein thecartridge body further comprises a longitudinal slot configured toreceive a cutting member, wherein the first compression zone is alignedwith the longitudinal slot, and wherein the second compression zone isaligned with the staple cavities.Example 67—The staple cartridge assembly of Examples 62, 63, 64, 65, or66, wherein the cartridge body comprises a proximal end and a distalend, wherein the first compression zone is aligned with the proximalend, and wherein the second compression zone is positioned distally withrespect to the first compression zone.Example 68—The staple cartridge assembly of Examples 62, 63, 64, 65, 66,or 67, wherein the cartridge body further comprises a longitudinal slotconfigured to receive a cutting member, and wherein the pillar wallsextend across the longitudinal slot.Example 69—The staple cartridge assembly of Examples 62, 63, 64, 65, 66,67, or 68, wherein each the structural fiber comprises a longitudinalseam that extends between a proximal end and a distal end of thecartridge body.Example 70—The staple cartridge assembly of Examples 62, 63, 64, 65, 66,67, 68, or 69, wherein each the reinforcement fiber comprises a lateralseam that extends through a pillar wall.Example 71—The staple cartridge assembly of Examples 62, 63, 64, 65, 66,67, 68, 69, or 70, wherein the structural fibers are comprised of afirst material, and wherein the reinforcement fibers are comprised of asecond material which is different than the first material.Example 72—The staple cartridge assembly of Examples 62, 63, 64, 65, 66,67, 68, 69, 70, or 71, wherein the reinforcement fibers are knotted withthe structural fibers.Example 73—The staple cartridge assembly of Examples 62, 63, 64, 65, 66,67, 68, 69, 70, 71, or 72, wherein the implantable layer comprises afirst compression zone comprising a first density of knots between thereinforcement fibers and the structural fibers and a second compressionzone comprises a second density of knots between the reinforcementfibers and the structural fibers, wherein the second density is greaterthan the first density.Example 74—A staple cartridge assembly comprising a cartridge bodycomprising a deck and a plurality of staple cavities defined in thedeck, a plurality of staples stored in the staple cavities, and animplantable layer positioned over the staple cavities, wherein theimplantable layer comprises interconnected structural walls comprised ofinterwoven fibers and pockets defined between the structural walls.Example 75—The staple cartridge assembly of Example 74, wherein thestructural walls are comprised of structural fibers weaved into a topsurface, a bottom surface, and pillar walls extending between the topsurface and the bottom surface and reinforcement fibers interwovenwithin the pillar walls.Example 76—The staple cartridge assembly of Example 75, wherein thereinforcement fibers are looped around the structural fibers.Example 77—The staple cartridge assembly of Examples 75 or 76, whereinthe implantable layer comprises a first compression zone comprising afirst density of loops between the reinforcement fibers and thestructural fibers and a second compression zone comprises a seconddensity of loops between the reinforcement fibers and the structuralfibers, wherein the second density is greater than the first density.Example 78—The staple cartridge assembly of Example 77, wherein thecartridge body further comprises a longitudinal slot configured toreceive a cutting member, wherein the first compression zone is alignedwith the longitudinal slot, and wherein the second compression zone isaligned with the staple cavities.Example 79—The staple cartridge assembly of Examples 77 or 78, whereinthe cartridge body comprises a proximal end and a distal end, whereinthe first compression zone is aligned with the proximal end, and whereinthe second compression zone is positioned distally with respect to thefirst compression zone.Example 80—The staple cartridge assembly of Examples 75, 76, 77, 78, or79, wherein the structural fibers are comprised of a first material, andwherein the reinforcement fibers are comprised of a second materialwhich is different than the first material.Example 81—The staple cartridge assembly of Examples 75, 76, 77, 78, 79,or 80, wherein the cartridge body further comprises a longitudinal slotconfigured to receive a cutting member, and wherein the structural wallsextend across the longitudinal slot.Example 82—The staple cartridge assembly of Examples 75, 76, 77, 78, 79,80, or 81, wherein the structural walls comprise longitudinal seams thatextend between a proximal end and a distal end of the cartridge body.Example 83—The staple cartridge assembly of Example 82, wherein thestructural walls further comprise lateral seams that extend transverselyto the longitudinal seams.Example 84—A staple cartridge assembly comprising a cartridge bodycomprising a deck and a plurality of staple cavities defined in thedeck, a plurality of staples stored in the staple cavities, and animplantable layer positioned over the staple cavities, wherein theimplantable layer comprises a top portion, a bottom portion, and wallsinterwoven between the top portion and the bottom portion.Example 85—A compressible adjunct comprising a first portion, a secondportion, and a middle portion, wherein the middle portion is disposedbetween the first portion and the second portion, and wherein the middleportion comprises a first pillar, a second pillar, wherein the firstpillar and the second pillar extend substantially between the firstportion and the second portion, and an interconnecting member, whereinthe interconnecting member is configured to engage at least the firstpillar and the second pillar, wherein when the compressible adjunct iscompressed by a force, the first pillar is configured to deflect a firstdeflection and the second pillar is configured to deflect a seconddeflection, and wherein the first deflection differs from the seconddeflection.Example 86—The compressible adjunct of Example 85, wherein theinterconnecting member fixably engages the first pillar and the secondpillar.Example 87—The compressible adjunct of Examples 85 or 86, wherein theinterconnecting member slidingly engages the first pillar and the secondpillar.Example 88—The compressible adjunct of Examples 85, 86, or 87, whereinthe first pillar comprises a first cross sectional diameter, wherein thesecond pillar comprises a second cross sectional diameter, and whereinthe first diameter differs from the second diameter.Example 89—The compressible adjunct of Example 88, wherein the firstcross sectional diameter is greater than the second cross sectionaldiameter, and wherein the second deflection is greater than the firstdeflection.Example 90—The compressible adjunct of Examples 85, 86, 87, 88, or 89,wherein the first pillar comprises a first density, wherein the secondpillar comprises a second density, and wherein the first density differsfrom the second density.Example 91—The compressible adjunct of Example 90, wherein the firstdensity is greater than the second density, and wherein the seconddeflection is greater than the first deflection.Example 92—The compressible adjunct of Examples 85, 86, 87, 88, 89, 90,or 91, wherein the first pillar comprises a first cross sectionaldiameter, wherein the second pillar comprises a second cross sectionaldiameter, wherein the interconnecting member comprises a third crosssectional diameter, and wherein the first cross sectional diameter andthe second cross sectional diameter differ from the third crosssectional diameter.Example 93—The compressible adjunct of Examples 85, 86, 87, 88, 89, 90,91, or 92, wherein the first pillar comprises a first density, whereinthe second pillar comprises a second density, wherein theinterconnecting member comprises a third density, and wherein the firstdensity and the second density differ from the third density.Example 94—The compressible adjunct of Examples 85, 86, 87, 88, 89, 90,91, 92, or 93, wherein the first pillar comprises a first end, a secondend, and a middle section, wherein the first end engages the firstportion, wherein the second end engages the second portion, and whereinthe interconnecting member engages the middle section.Example 95—A compressible adjunct comprising a base portion and aplurality of pillars, wherein the plurality of pillars comprises a firstsupport comprising a first pillar, and a second pillar, wherein thefirst pillar and the second pillar engage the base portion, and whereinthe first pillar and the second pillar are interconnected. The pluralityof pillars further comprises a second support comprising a third pillarand a fourth pillar, wherein the third pillar and the fourth pillarengage the base portion, wherein the third pillar and the fourth pillarare interconnected, wherein when the compressible adjunct is compressedby a force, the first support is configured to deflect a firstdeflection and the second support is configured to deflect a seconddeflection, and wherein the first deflection differs from the seconddeflection.Example 96—The compressible adjunct of Example 95, wherein the firstsupport comprises a first material, and wherein the second supportcomprises a second material, and wherein the first material differs fromthe second material.Example 97—The compressible adjunct of Examples 95 or 96, wherein thefirst support has a first average density, and wherein the secondsupport has a second average density, and wherein the first averagedensity differs from the second average density.Example 98—The compressible adjunct of Example 97, wherein the firstaverage density is greater than the second average density, and whereinthe second deflection is greater than the first deflection.Example 99—The compressible adjunct of Examples 95, 96, 97, or 98,wherein the first pillar comprises a first cross sectional diameter,wherein the second pillar comprises a second cross sectional diameter,and wherein the first diameter differs from the second diameter.Example 100—The compressible adjunct of Examples 95, 96, 97, 98, or 99,wherein the first pillar comprises a first cross sectional diameter,wherein the second pillar comprises a second cross sectional diameter,wherein the third pillar comprises a third cross sectional diameter, andwherein the fourth pillar comprises a fourth cross sectional diameter.Example 101—The compressible adjunct of Example 100, wherein the firstdiameter differs from the third diameter, and wherein the seconddiameter differs from the fourth diameter.Example 102—The compressible adjunct of Examples 95, 96, 97, 98, 99,100, or 101, wherein the first support comprises an first averageheight, wherein the second support comprises an second average height,and wherein the first height differs from the second height.Example 103—The compressible adjunct of Example 102, wherein the firstaverage height is greater than the second average height and the firstdeflection is greater than the second deflection.Example 104—The compressible adjunct of Examples 95, 96, 97, 98, 99,100, 101, 102, or 103, wherein the first pillar and the second pillarare woven together, and wherein when the compressible adjunct iscompressed, the first pillar and the second pillar are configured topartially unwind.Example 105—A method of producing a fibrous compressible construct witha desired thickness, wherein the method comprises the steps of, one,producing a biocompatible melt-blown non-woven substrate that comprisesa thickness lesser than the desired thickness, wherein the biocompatiblemelt-blown non-woven substrate comprises a plurality of fibers and, two,applying a gas sorption process to the biocompatible melt-blownnon-woven substrate to modify the thickness to the desired thickness.Example 106—The method of Example 105, wherein the step of applying thegas sorption process comprises applying a high pressure gas to thebiocompatible melt-blown non-woven substrate.Example 107—The method of Examples 105 or 106, wherein the step ofproducing the biocompatible melt-blown non-woven substrate comprisesextruding a polymer, attenuating the extrudates into fibers by action ofa high-temperature and high-speed gas, and collecting the fibers to forma fibrous non-woven fabric.Example 108—The method of Examples 105, 106, or 107, wherein the step ofapplying a gas sorption process comprises, one, applying a high pressuregas to the biocompatible melt-blown non-woven substrate and, two,reducing the pressure of the gas.

In various circumstances, one or more of the compressible adjuncts ofthe present disclosure is comprised of one or more biocompatiblematerials. A compressible adjunct may comprise a polymeric composition.The polymeric composition may comprise one or more synthetic polymerand/or one or more non-synthetic polymer. The synthetic polymer maycomprise a synthetic absorbable polymer and/or a syntheticnon-absorbable polymer. In various circumstances, the polymericcomposition may comprise a porous structure with a uniform poremorphology or a gradient pore morphology (i.e. small pores graduallyincreasing in size to large pores across the thickness of the foam inone direction).

In various circumstances, a compressible adjunct has a porous morphologywhich exhibits a gradient structure such as, for example, small pores onone surface and larger pores on the other surface. Such morphology couldbe more optimal for tissue in-growth or hemostatic behavior. Further,the gradient could be also compositional with a varying bio-absorptionprofile. A short term absorption profile may be preferred to addresshemostasis while a long term absorption profile may address bettertissue healing without leakages.

In various circumstances, the polymeric composition may comprise apharmaceutically active agent. The polymeric composition may release atherapeutically effective amount of the pharmaceutically active agent.In various circumstances, the pharmaceutically active agent may bereleased as the polymeric composition is desorbed/absorbed. In variouscircumstances, the pharmaceutically active agent may be released intofluid, such as, for example, blood, passing over or through thepolymeric composition.

The entire disclosures of:

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U.S. Patent Application Publication No. 2007/0175955, entitled SURGICALCUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM,filed Jan. 31, 2006; and

U.S. Patent Application Publication No. 2010/0264194, entitled SURGICALSTAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed Apr. 22,2010, now U.S. Pat. No. 8,308,040, are hereby incorporated by referenceherein.

Although the various embodiments of the devices have been describedherein in connection with certain disclosed embodiments, manymodifications and variations to those embodiments may be implemented.Also, where materials are disclosed for certain components, othermaterials may be used. Furthermore, according to various embodiments, asingle component may be replaced by multiple components, and multiplecomponents may be replaced by a single component, to perform a givenfunction or functions. The foregoing description and following claimsare intended to cover all such modification and variations.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination.Upon cleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

By way of example only, aspects described herein may be processed beforesurgery. First, a new or used instrument may be obtained and whennecessary cleaned. The instrument may then be sterilized. In onesterilization technique, the instrument is placed in a closed and sealedcontainer, such as a plastic or TYVEK bag. The container and instrumentmay then be placed in a field of radiation that can penetrate thecontainer, such as gamma radiation, x-rays, or high-energy electrons.The radiation may kill bacteria on the instrument and in the container.The sterilized instrument may then be stored in the sterile container.The sealed container may keep the instrument sterile until it is openedin a medical facility. A device also may be sterilized using any othertechnique known in the art, including but not limited to beta or gammaradiation, ethylene oxide, plasma peroxide, or steam.

While this invention has been described as having exemplary designs, thepresent invention may be further modified within the spirit and scope ofthe disclosure. This application is therefore intended to cover anyvariations, uses, or adaptations of the invention using its generalprinciples.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

What is claimed is:
 1. A staple cartridge assembly for use with asurgical stapling instrument, wherein the staple cartridge assemblycomprises: a staple cartridge, comprising: a plurality of staples; and acartridge deck; and a compressible adjunct positionable against thecartridge deck, wherein the staples are deployable into tissue capturedagainst the compressible adjunct, and wherein the compressible adjunctcomprises: a first biocompatible layer; a second biocompatible layer,wherein the first biocompatible layer and the second biocompatible layerare configured to define an intermediate portion therebetween;structural cells extending in the intermediate portion, wherein thestructural cells cause the intermediate portion of the compressibleadjunct to be more porous than the first biocompatible layer and thesecond biocompatible layer, and wherein the structural cells areconfigured to define first openings comprising a first size; and secondopenings comprising a second size different than the first size, andwherein the first openings and the second openings cooperate to define acontinuous path through the compressible adjunct between the firstbiocompatible layer and the second biocompatible layer.
 2. The staplecartridge assembly of claim 1, wherein the first openings vary in size.3. The staple cartridge assembly of claim 1, wherein the firstbiocompatible layer defines a first external surface of the compressibleadjunct and the second biocompatible layer defines a second externalsurface of the compressible adjunct, and wherein the continuous pathextends from the first external surface to the second external surfacethrough the intermediate portion.
 4. The staple cartridge assembly ofclaim 1, wherein the second openings interconnect the first openings ofadjacent ones of the structural cells.
 5. The staple cartridge assemblyof claim 4, wherein the compressible adjunct comprises a side attachmentthat defines a continuous attachment surface between the firstbiocompatible layer and the second biocompatible layer.
 6. The staplecartridge assembly of claim 1, wherein the second openings are smallerin size than the first openings.
 7. The staple cartridge assembly ofclaim 1, wherein the second openings define perforations in walls of thestructural cells.
 8. The staple cartridge assembly of claim 1, whereinthe second openings are laser drilled into the compressible adjunct. 9.The staple cartridge assembly of claim 1, wherein the second openingsare smaller than a tenth of the size of the first openings.
 10. A staplecartridge assembly for use with a surgical stapling instrument, whereinthe staple cartridge assembly comprises: a staple cartridge, comprising:a plurality of staples; and a cartridge deck; and a compressible adjunctpositionable against the cartridge deck, wherein the staples aredeployable into tissue captured against the compressible adjunct, andwherein the compressible adjunct comprises: a tissue contacting surface;a cartridge-deck contacting surface, wherein the tissue contactingsurface and the cartridge-deck contacting surface are configured todefine an intermediate portion therebetween; structural cells extendingin the intermediate portion, and wherein the structural cells areconfigured to define first openings comprising a first size; and secondopenings comprising a second size different than the first size, andwherein the first openings and the second openings cooperate to define acontinuous path through the compressible adjunct between the tissuecontacting surface and the cartridge-deck contacting surface through theintermediate portion.
 11. The staple cartridge assembly of claim 10,wherein the first openings vary in size.
 12. The staple cartridgeassembly of claim 10, wherein the second openings interconnect the firstopenings of adjacent ones of the structural cells.
 13. The staplecartridge assembly of claim 12, wherein the compressible adjunctcomprises a side attachment that defines a continuous attachment surfacebetween the tissue contacting surface and the cartridge-deck contactingsurface.
 14. The staple cartridge assembly of claim 10, wherein thesecond openings are smaller in size than the first openings.
 15. Thestaple cartridge assembly of claim 10, wherein the second openingsdefine perforations in walls of the structural cells.
 16. The staplecartridge assembly of claim 10, wherein the second openings are laserdrilled into the compressible adjunct.
 17. The staple cartridge assemblyof claim 10, wherein the second openings are smaller than a tenth of thesize of the first openings.